ADA: Metabolic Syndrome Helps Predict Mortality Risk

CHICAGO, June 26 -- Metabolic syndrome and its components helped predict mortality for diabetic and non-diabetic patients alike, independently of Framingham cardiovascular risk, researchers found.
In a large study of patients at a preventive cardiology clinic, metabolic syndrome was associated with 53% higher mortality risk than seen among patients who did not have diabetes or metabolic syndrome, said Krupa B. Doshi, M.D., of the Cleveland Clinic, and colleagues.
Fasting plasma glucose and waist circumference-components of metabolic syndrome-were significant predictors of mortality risk in an analysis that adjusted for Framingham score and other factors (P<0.05 for both), they reported at the American Diabetes Association meeting here.
Their findings suggest that the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines on metabolic syndrome do have clinical relevance, Dr. Doshi said.
"It does help identify the group of patients that need aggressive risk management," she said.
The researchers retrospectively reviewed outcomes for patients who were referred to their cardiology clinic for primary or secondary prevention and seen from 1995 to 2006.
Among the patients, 1,189 had diabetes, 1,241 had metabolic syndrome (met more than three of the NCEP ATP III criteria) but not diabetes, and 3,023 had neither.
Overall there were 360 deaths.
Mortality rates were highest for patients with diabetes (hazard ratio 2.97, 95% confidence interval 2.33 to 3.79, P<0.001), followed by those with metabolic syndrome (HR 1.53, 95% CI 1.17 to 2.01, P=0.002) compared with the group with neither condition.
Other outcome measures showed the same pattern. Occurrence of cardiovascular events was significantly higher among patients with diabetes than among those with metabolic syndrome and among metabolic syndrome patients than among those who had neither condition, respectively, for coronary artery bypass grafts (P<0.01 and P=0.017), chronic heart failure (P<0.001 and P=0.001), myocardial infarction (P=0.001 and P<0.001), and peripheral arterial disease (P<0.001 and P=NS).
In a multivariate analysis adjusted for Framingham score, age, gender, total cholesterol, and fibrinogen, the findings for patients with metabolic syndrome were:
Fasting plasma glucose was a significant contributor to mortality risk (concordance index 0.779, P<0.05).
Waist circumference was a significant contributor to mortality risk (concordance index 0.766, P<0.05).
Blood pressure, high-density lipoprotein cholesterol, triglycerides, and body mass index were not significant contributors to mortality risk by themselves.
The researchers concluded, "Both NCEP metabolic syndrome and Framingham scores are very informative." They "suggest coordinated use to predict mortality in a high-risk cohort."
The study was supported in part by the National Institutes of Health.Primary source: American Diabetes Association meetingSource reference: Doshi KB, et al "Mortality and Cardiovascular Events Increased in Non-diabetic Subjects with Metabolic Syndrome; Fasting Glucose a Strong Predictor of Increased Mortality: A PRECIS Database Cohort Study" ADA meeting 2007; Abstract 975-P.