Advanced Biomedical Research

Which Components of Metabolic Syndrome have a Greater Effect on Mortality, CVA and Myocardial Infarction, Hyperglycemia, High Blood Pressure or Both?

Document Type : Original Article

Authors

Department of Cardiology, Sedigheh Tahereh Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: This study aims to evaluate the incidence of stroke, ischemic heart disease (IHD), and cardiovascular disease (CVD) mortality in clusters containing hypertension (HTN), clusters containing diabetes (diabetes mellitus [DM]), cluster with both HTN, DM, and cluster without HTN, DM in patients with metabolic syndrome (MetS). Materials and Methods: The association between MetS and outcomes was examined in 2257 patients with MetS that were divided into four groups includes patients with MetS with hyperglycemia (Cluster 1), patients with MetS with HTN (Cluster 2), patients with MetS with HTN and hyperglycemia (Cluster 3) and patients with MetS without HTN and hyperglycemia (Cluster 4). To assess the risk ratio and incidence of CVA, myocardial infarction, and mortality with the use multivariate Cox proportional hazards models. Results: As it shown the lowest prevalence of events was in Cluster 1 and against in Cluster 3 the prevalence of stroke with 34 (38.2%) cases and the prevalence of IHD and CVD mortality in Cluster 2 with, respectively, 168 (54.7%) and 51 patients (49%) had the most frequencies (P < 0.001), and hence that the lowest prevalence of events was seen in Cluster 1, but stroke in Cluster 3 with 34 cases (38.2%) and the prevalence of IHD and CVD mortality in Cluster 2, respectively, with 168 (54.7%) and 51 patients (49%) had the most frequencies (P < 0.001). Conclusion: More intensive changes in lifestyle and management protocols may be required in these patients for controlling the components of the syndrome, with the aim of preventing not only type II diabetes and CVD but also ischemic cerebrovascular events.

Keywords

1.
Galassi A, Reynolds K, He J. Metabolic syndrome and risk of cardiovascular disease: A meta-analysis. Am J Med 2006;119:812-9.  Back to cited text no. 1
    
2.
Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: A summary of the evidence. Diabetes Care 2005;28:1769-78.  Back to cited text no. 2
    
3.
Rachas A, Raffaitin C, Barberger-Gateau P, Helmer C, Ritchie K, Tzourio C, et al. Clinical usefulness of the metabolic syndrome for the risk of coronary heart disease does not exceed the sum of its individual components in older men and women. The Three-City (3C) Study. Heart 2012;98:650-5.  Back to cited text no. 3
    
4.
Amirkalali B, Fakhrzadeh H, Sharifi F, Kelishadi R, Zamani F, Asayesh H, et al. Prevalence of metabolic syndrome and its components in the Iranian adult population: A systematic review and meta-analysis. Iran Red Crescent Med J 2015;17:e24723.  Back to cited text no. 4
    
5.
Hadaegh F, Mohebi R, Cheraghi L, Tohidi M, Moghaddam NB, Bozorogmanesh M, et al. Do different metabolic syndrome definitions predict cerebrovascular events and coronary heart disease independent of their components? 9 years follow-up of the Tehran lipid and glucose study. Stroke 2012;43:1669-71.  Back to cited text no. 5
    
6.
Hadaegh F, Hasheminia M, Lotfaliany M, Mohebi R, Azizi F, Tohidi M. Incidence of metabolic syndrome over 9 years follow-up; the importance of sex differences in the role of insulin resistance and other risk factors. PLoS One 2013;8:e76304.  Back to cited text no. 6
    
7.
Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, et al. Metabolic syndrome and risk of incident cardiovascular events and death: A systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol 2007;49:403-14.  Back to cited text no. 7
    
8.
Khosravi-Boroujeni H, Ahmed F, Sadeghi M, Roohafza H, Talaei M, Dianatkhah M, et al. Does the impact of metabolic syndrome on cardiovascular events vary by using different definitions? BMC Public Health 2015;15:1313.  Back to cited text no. 8
    
9.
Esteghamati A, Hafezi-Nejad N, Sheikhbahaei S, Heidari B, Zandieh A, Ebadi M, et al. Risk of coronary heart disease associated with metabolic syndrome and its individual components in Iranian subjects: A matched cohort study. J Clin Lipidol 2014;8:279-86.  Back to cited text no. 9
    
10.
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: Findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287:356-9.  Back to cited text no. 10
    
11.
Bender R, Jöckel KH, Richter B, Spraul M, Berger M. Body weight, blood pressure, and mortality in a cohort of obese patients. Am J Epidemiol 2002;156:239-45.  Back to cited text no. 11
    
12.
Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol 2008;28:629-36.  Back to cited text no. 12
    
13.
Delavari A, Forouzanfar MH, Alikhani S, Sharifian A, Kelishadi R. First nationwide study of the prevalence of the metabolic syndrome and optimal cutoff points of waist circumference in the Middle East: The national survey of risk factors for noncommunicable diseases of Iran. Diabetes Care 2009;32:1092-7.  Back to cited text no. 13
    
14.
Azizi F, Salehi P, Etemadi A, Zahedi-Asl S. Prevalence of metabolic syndrome in an urban population: Tehran Lipid and Glucose Study. Diabetes Res Clin Pract 2003;61:29-37.  Back to cited text no. 14
    
15.
Sarrafzadegan N, Talaei M, Sadeghi M, Kelishadi R, Oveisgharan S, Mohammadifard N, et al. The Isfahan cohort study: Rationale, methods and main findings. J Hum Hypertens 2011;25:545-53.  Back to cited text no. 15
    
16.
Topic E, Meško Brguljan P, Blaton V. New Trends in Classification, Monitoring and Management of Metabolic Syndrome: Handbook. The 6th FESCC Continuous Postgraduate Course in Clinical Chemistry; 2006. p. 10. Available https://books.google.com/books/about/New_trends_in_classification_monitoring.html?id=65K5GQAACAAJ  Back to cited text no. 16
    
17.
Møller Pedersen SF, Jepsen JR. The metabolic syndrome among Danish seafarers. Int Marit Health 2013;64:183-90.  Back to cited text no. 17
    
18.
Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: An 8-year follow-up of 14 719 initially healthy American women. Circulation 2003;107:391-7.  Back to cited text no. 18
    
19.
Olijhoek JK, van der Graaf Y, Banga JD, Algra A, Rabelink TJ, Visseren FL; SMART Study Group. The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm. Eur Heart J 2004;25:342-8.  Back to cited text no. 19
    
20.
Hanson RL, Imperatore G, Bennett PH, Knowler WC. Components of the “metabolic syndrome” and incidence of type 2 diabetes. Diabetes 2002;51:3120-7.  Back to cited text no. 20
    
21.
Resnick HE, Jones K, Ruotolo G, Jain AK, Henderson J, Lu W, et al. Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease in nondiabetic American Indians: The Strong Heart Study. Diabetes Care 2003;26:861-7.  Back to cited text no. 21
    
22.
Klein BE, Klein R, Lee KE. Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in Beaver Dam. Diabetes Care 2002;25:1790-4.  Back to cited text no. 22
    
23.
Sattar N, Gaw A, Scherbakova O, Ford I, O'Reilly DS, Haffner SM, et al. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 2003;108:414-9.  Back to cited text no. 23
    
24.
Zimmet PZ, Alberti KG, Shaw J. International diabetes federation: The IDF consensus worldwide definition of the metabolic syndrome. Diabetes Voice 2005;50:31-3.  Back to cited text no. 24
    
25.
Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683-9.  Back to cited text no. 25
    
26.
Stern MP, Williams K, González-Villalpando C, Hunt KJ, Haffner SM. Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease? Diabetes Care 2004;27:2676-81.  Back to cited text no. 26
    
27.
Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA. Metabolic syndrome and development of diabetes mellitus: Application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol 2002;156:1070-7.  Back to cited text no. 27
    
28.
Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002;288:2709-16.  Back to cited text no. 28
    
29.
Girman CJ, Rhodes T, Mercuri M, Pyörälä K, Kjekshus J, Pedersen TR, et al. The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). Am J Cardiol 2004;93:136-41.  Back to cited text no. 29
    
30.
National Center for Health Statistics (US). National Health and Nutrition Examination Survey. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2008.  Back to cited text no. 30
    
31.
Lawlor DA, Smith GD, Ebrahim S. Does the new international diabetes federation definition of the metabolic syndrome predict CHD any more strongly than older definitions? Findings from the British Women's Heart and Health Study. Diabetologia 2006;49:41-8.  Back to cited text no. 31
    
32.
Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.  Back to cited text no. 32
    
33.
Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539-53.  Back to cited text no. 33
    
34.
World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO Consultation. Geneva: World Health Organization; 1999.  Back to cited text no. 34
    
35.
Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993;16:434-44.  Back to cited text no. 35
    
36.
Wei M, Mitchell BD, Haffner SM, Stern MP. Effects of cigarette smoking, diabetes, high cholesterol, and hypertension on all-cause mortality and cardiovascular disease mortality in Mexican Americans. The San Antonio Heart Study. Am J Epidemiol 1996;144:1058-65.  Back to cited text no. 36
    
37.
Mozaffarian D, Kamineni A, Prineas RJ, Siscovick DS. Metabolic syndrome and mortality in older adults: The Cardiovascular Health Study. Arch Intern Med 2008;168:969-78.  Back to cited text no. 37
    
38.
Ginsberg HN. Treatment for patients with the metabolic syndrome. Am J Cardiol 2003;91:29E-39E.  Back to cited text no. 38
    
39.
Haffner SM, Miettinen H, Stern MP. Relatively more atherogenic coronary heart disease risk factors in prediabetic women than in prediabetic men. Diabetologia 1997;40:711-7.  Back to cited text no. 39
Advanced Biomedical Research
Volume 2017, september
September 2017
Pages 1-8