title: Metabolic syndrome is independently associated with increased 20-year mortality in patients with stable coronary artery disease.
abstract: BACKGROUND
  Data regarding long-term association of metabolic syndrome (MetS) with adverse outcomes are conflicting. We aim to determine the independent association of MetS (based on its different definitions) with 20 year all-cause mortality among patients with stable coronary artery disease (CAD).
  
  
  METHODS
  Our study comprised 15,524 patients who were enrolled in the Bezafibrate Infarction Prevention registry between February 1, 1990, and October 31, 1992, and subsequently followed-up for the long-term mortality through December 31, 2014. MetS was defined according to two definitions: The International Diabetes Federation (IDF); and the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP).
  
  
  RESULTS
  According to the IDF criteria 2122 (14%) patients had MetS, whereas according to the NCEP definition 7446 (48%) patients had MetS. Kaplan-Meier survival analysis showed that all-cause mortality was significantly higher among patients with MetS defined by both the IDF (67 vs. 61%; log rank-p < 0.001) as well as NCEP (67 vs. 54%; log rank-p < 0.001) criteria. Multivariate adjusted mortality risk was 17% greater [Hazard Ratio (HR) 1.17; 95% Confidence Interval (CI) 1.07-1.28] in patients with MetS according to IDF and 21% (HR 1.21; 95% CI 1.13-1.29) using the NCEP definition. Subgroup analysis demonstrated that long-term increased mortality risk associated with MetS was consistent among most clinical subgroups excepted patients with renal failure (p value for interaction < 0.05).
  
  
  CONCLUSIONS
  Metabolic syndrome is independently associated with an increased 20-year all-cause mortality risk among patients with stable CAD. This association was consistent when either the IDF or NCEP definitions were used. Trial registration retrospective registered.
authors: The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sheba Road 2, 52620, Ramat Gan, Israel. or.younis@gmail.com.
authors: Arwa
authors: A
authors: Younis
authors: The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sheba Road 2, 52620, Ramat Gan, Israel.
authors: Anan
authors: A
authors: Younis
authors: The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sheba Road 2, 52620, Ramat Gan, Israel.
authors: Boaz
authors: B
authors: Tzur
authors: The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sheba Road 2, 52620, Ramat Gan, Israel.
authors: Yael
authors: Y
authors: Peled
authors: The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sheba Road 2, 52620, Ramat Gan, Israel.
authors: Nir
authors: N
authors: Shlomo
authors: The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sheba Road 2, 52620, Ramat Gan, Israel.|Sakler School of Medicine, Tel Aviv University, Ramat Gan, Israel.|Heart Research Follow-up Program, University of Rochester, Rochester, NY, USA.
authors: Ilan
authors: I
authors: Goldenberg
authors: Sakler School of Medicine, Tel Aviv University, Ramat Gan, Israel.|Cardiovascular Diabetology Research Foundation, Holon, Israel.
authors: Enrique Z
authors: EZ
authors: Fisman
authors: The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sheba Road 2, 52620, Ramat Gan, Israel.|Sakler School of Medicine, Tel Aviv University, Ramat Gan, Israel.|Cardiovascular Diabetology Research Foundation, Holon, Israel.
authors: Alexander
authors: A
authors: Tenenbaum
authors: The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sheba Road 2, 52620, Ramat Gan, Israel.|Sakler School of Medicine, Tel Aviv University, Ramat Gan, Israel.
authors: Robert
authors: R
authors: Klempfner
mesh_terms: D000367:Age Factors; D000368:Aged; D001629:Bezafibrate / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D051437:Renal Insufficiency / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000960:Hypolipidemic Agents; D001629:Bezafibrate
keywords: All-cause mortality; Long term outcomes; Metabolic syndrome; Prognosis; Stable coronary artery disease