Eberly Lynn E, Prineas Ronald, Cohen Jerome D, Vazquez Gabriela, Zhi Xin, Neaton James D, Kuller Lewis H
Division of Biostatistics, School of Public Health, University of Minnesota, 420 Delaware St., SE, MMC 303, Minneapolis, Minnesota 55455-0378, USA.
Diabetes Care. 2006 Jan;29(1):123-30. doi: 10.2337/diacare.29.1.123.
To examine the long-term association of metabolic syndrome with mortality among those at high risk for cardiovascular disease (CVD).
A total of 10,950 Multiple Risk Factor Intervention Trial (MRFIT) survivors were followed for mortality an additional median 18.4 years (1980-1999). Proportional hazards models examined multivariate-adjusted risks associated with Adult Treatment Panel III-defined metabolic syndrome conditions, with BMI substituted for waist circumference.
At MRFIT annual visit 6, 4,588 (41.9%) men, mean age (+/-SD) 53.0 +/- 5.9 years, had metabolic syndrome and 6,362 did not. Comparing men with metabolic syndrome to men without, adjusted hazard ratios (HRs) were 1.21 (95% CI 1.13-1.29), 1.49 (1.35-1.64), and 1.51 (1.34-1.70) for 18-year total, CVD, and coronary heart disease mortality, respectively. Among men with metabolic syndrome, elevated glucose (1.54 [1.34-1.78]) and low HDL cholesterol (1.45 [1.17-1.54]) were most predictive of CVD mortality, followed by elevated BMI (1.34 [1.17-1.54]), elevated blood pressure (1.25 [0.98-1.58]), and elevated triglycerides (1.06 [0.86-1.30]). In contrast, for men without metabolic syndrome, the HR for low HDL cholesterol was 1.02 (0.86-1.22). Among metabolic syndrome men with no nonfatal CVD event, smokers with elevated LDL cholesterol showed higher CVD mortality (1.79 [1.22-2.63]) compared with nonsmokers without elevated LDL cholesterol; this additional risk was even greater for metabolic syndrome men with a nonfatal CVD event (2.11 [1.32-3.38]).
Metabolic syndrome is associated with an increased risk of mortality. Among those with metabolic syndrome, risk is further increased by having more metabolic syndrome conditions, by cigarette smoking, and by elevated LDL cholesterol. Primary prevention of each metabolic syndrome condition should be emphasized, and presence of each condition should be treated in accordance with current guidelines.
研究代谢综合征与心血管疾病（CVD）高危人群死亡率之间的长期关联。
对10950名多重危险因素干预试验（MRFIT）幸存者进行了为期18.4年（1980 - 1999年）的随访以观察死亡率。采用比例风险模型研究与成人治疗小组第三次定义的代谢综合征状况相关的多变量调整风险，用体重指数替代腰围。
在MRFIT第6次年度随访时，4588名（41.9%）男性，平均年龄（±标准差）为53.0±5.9岁，患有代谢综合征，6362名男性未患。将患有代谢综合征的男性与未患代谢综合征的男性相比，18年总死亡率、CVD死亡率和冠心病死亡率的调整风险比（HRs）分别为1.21（95%置信区间1.13 - 1.29）、1.49（1.35 - 1.64）和1.51（1.34 - 1.70）。在患有代谢综合征的男性中，血糖升高（1.54[1.34 - 1.78]）和高密度脂蛋白胆固醇降低（1.45[1.17 - 1.54]）最能预测CVD死亡率，其次是体重指数升高（1.34[1.17 - 1.54]）、血压升高（1.25[0.98 - 1.58]）和甘油三酯升高（1.06[0.86 - 1.30]）。相比之下，对于没有代谢综合征的男性，高密度脂蛋白胆固醇降低的HR为1.02（0.86 - 1.22）。在没有非致死性CVD事件的代谢综合征男性中，低密度脂蛋白胆固醇升高的吸烟者与低密度脂蛋白胆固醇未升高的非吸烟者相比，CVD死亡率更高（1.79[1.22 - 2.63]）；对于有非致死性CVD事件的代谢综合征男性，这种额外风险更大（2.11[1.32 - 3.38]）。
代谢综合征与死亡风险增加相关。在患有代谢综合征的人群中，更多的代谢综合征状况、吸烟和低密度脂蛋白胆固醇升高会进一步增加风险。应强调对每种代谢综合征状况的一级预防，并且应根据当前指南对每种状况进行治疗。
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