title: Does the impact of metabolic syndrome on cardiovascular events vary by using different definitions?
abstract: BACKGROUND
  Metabolic Syndrome (MetS) is a complex disorder which increases the risk of chronic diseases, including cardiovascular diseases and diabetes mellitus. As a result of modern lifestyles, the prevalence of MetS has been rising globally. This study aims to investigate whether overall prevalence of MetS varies when using different definitions of MetS and to identify the best and most predictive definition of the MetS for cardiovascular disease (CVD) events over 10 years in a cohort of an Iranian population.
  
  
  METHODS
  Adults aged ≥ 35 years from urban and rural regions in central Iran were selected at baseline and followed up for more than 10 years. Data on socio-demographic characteristics, anthropometry, blood pressure and smoking status were collected at baseline. In addition, various biochemical indices were assessed. MetS was defined based on five available definitions, and cardiovascular events during 10 years follow up were confirmed by an expert group. The hazard ratios were calculated by the Cox proportional hazards model.
  
  
  RESULTS
  The highest prevalence of MetS was observed by using AHA-NHBI definition (36.9%), followed by JIS definition (31.2%). On the other hand, EGIR (8.8%) provided the lowest prevalence. The risk of developing CVD, irrespective of definitions, was approximately two fold higher in the presence of MetS. After controlling for possible confounders, AHA-NHBI definition was found to be the best predictor of CVD.
  
  
  CONCLUSIONS
  This study demonstrated a great variability in the prevalence of MetS among Iranian adults when using different definitions of MetS. CVD risk was significantly higher in MetS participants, as well as in participants with any risk factors of MetS; however, the AHA-NHBI definition was found to be the best predictor of CVD. Thus protective measures, including lifestyle modifications, plus control of individual risk factors is necessary to prevent cardiovascular events.
authors.affiliation: Menzies Health Institute Queensland, and School of Medicine, Griffith University, Gold Coast Campus, QLD, Australia. Khosravi_bh@yahoo.com.
authors.forename: Hossein
authors.initials: H
authors.lastname: Khosravi-Boroujeni
authors.affiliation: Menzies Health Institute Queensland, and School of Medicine, Griffith University, Gold Coast Campus, QLD, Australia. f.ahmed@griffith.edu.au.
authors.forename: Faruk
authors.initials: F
authors.lastname: Ahmed
authors.affiliation: Isfahan Cardiac Rehabilitation Research Center, Cardiovascular Research Institue, Isfahan University of Medical Sciences, Isfahan, Iran. sadeghimasoumeh@gmail.com.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Sadeghi
authors.affiliation: Isfahan Cardiac Rehabilitation Research Center, Cardiovascular Research Institue, Isfahan University of Medical Sciences, Isfahan, Iran. hroohafza@gmail.com.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Roohafza
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. mtalaei@gmail.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Talaei
authors.affiliation: Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. dianatkhah.m@gmail.com.
authors.forename: Minoo
authors.initials: M
authors.lastname: Dianatkhah
authors.affiliation: Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. a.Pourmogaddas@gmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Pourmogaddas
authors.affiliation: Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. nsarrafzadegan@gmail.com.
authors.forename: Nizal
authors.initials: N
authors.lastname: Sarrafzadegan
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D012424:Rural Population; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D009626:Terminology as Topic; D014505:Urban Population