The metabolic syndrome predicts incident congestive heart failure: a 20-year follow-up study of elderly Finns.

OBJECTIVE

We investigated whether the metabolic syndrome (MetS) and its components defined by four different criteria including subjects with prevalent diabetes in their definitions were associated with congestive heart failure (CHF) independent of interim myocardial infarction (MI) and prevalent diabetes during a 20-year follow-up in an elderly population-based study.

METHODS AND RESULTS

The MetS was defined according to the World Health Organization (WHO), the National Cholesterol Education Program (NCEP), the International Diabetes Federation (IDF), and the American Heart Association and the National Heart, Lung, and Blood Institute (AHA) criteria. The association of the MetS with incident CHF (303 cases) was investigated with Cox regression analyses in a 20-year follow-up study of 1032 Finns, aged 65-74 years at baseline. Among all subjects the MetS by all four criteria was significantly associated with a 1.45-1.74-fold risk for incident CHF after the adjustment for confounding factors. When subjects with interim MI during the follow-up and with prevalent diabetes were excluded, the MetS was significantly associated with a 1.37-1.87-fold risk for incident CHF after the adjustment for confounding factors. Of the single components of the MetS, the following were associated with incident CHF: impaired fasting glucose (IFG) [fasting plasma glucose (FPG)> or = 6.1 mmol/l, Hazards ratio (HR) 1.46 or FPG > or = 5.6 mmol/l, HR 1.62)]; raised blood pressure (BP) [(BP > or = 140/90 mmHg or antihypertensive medications, HR 1.89); central obesity (waist circumference > or = 94 cm in men or > or = 80 cm in women, HR 1.49); (waist circumference > or = 102 cm in men or > or = 88 cm in women, HR 1.48); obesity (body mass index > or = 30 kg/m(2), HR 1.79); and low high-density lipoprotein cholesterol (<1.03 mmol/l in men or <1.29 mmol/l in women, HR 1.55).

CONCLUSIONS

The MetS defined by four different criteria predicted CHF independent of interim MI and prevalent diabetes in elderly Finns, but not above and beyond the risk associated with one component of the MetS, hypertension.