Centre d'Investigations Préventives et Cliniques (IPC Center), Paris, France.
J Hypertens. 2011 Apr;29(4):663-8. doi: 10.1097/HJH.0b013e32834320dc.
The metabolic syndrome predicts the risk of cardiovascular and all-cause death, but its clinical relevance in the elderly remains debatable. We aimed to determine the impact of the metabolic syndrome on all-cause mortality according to age, in comparison with hypertension alone.
We studied 129 655 participants (82 110 men and 47 545 women) undergoing a standard health check-up at the Investigations Préventives et Cliniques center (Paris, France). Mean follow-up was 4.9±2.6 years. The prevalence of the metabolic syndrome and its components was determined according to age group (<55, 55-65, >65 years old). All-cause mortality according to metabolic syndrome and age was determined using Cox regression model analysis, unadjusted or adjusted for age, sex, smoking and other confounding factors.
The prevalence of the metabolic syndrome and all its components except lipid parameters strongly increased with age. All-cause mortality associated with the metabolic syndrome (using three different definitions) was significantly elevated in participants below 55 years old, and was little affected by adjustment for confounding factors. However, it decreased from 1.77 (1.45-2.16) in participants below 55 years old to 1.12 (0.84-1.48) in participants above 65 years old [hazard ratio (95% confidence interval); National Cholesterol Education Program definition]. Waist circumference, fasting blood glucose and lipid parameters failed to predict mortality in participants above 65 years old. In contrast, hypertension (blood pressure>140/90 mmHg or treatment) remained a significant predictor of all-cause mortality [hazard ratio 1.30 (95% confidence interval 1.02-1.66)] in participants above 65 years old.
In a setting representative of primary care, hypertension but not the metabolic syndrome remains a strong risk factor for all-cause mortality in participants above 65 years old.
代谢综合征可预测心血管疾病和全因死亡风险，但它在老年人中的临床相关性仍存在争议。本研究旨在根据年龄确定代谢综合征与单纯高血压相比对全因死亡率的影响。
我们研究了在法国巴黎预防和临床研究中心接受标准健康检查的 129655 名参与者（82110 名男性和 47545 名女性）。平均随访时间为 4.9±2.6 年。根据年龄组（<55 岁、55-65 岁、>65 岁）确定代谢综合征及其各成分的患病率。使用 Cox 回归模型分析，在未调整和调整年龄、性别、吸烟和其他混杂因素后，根据代谢综合征和年龄确定全因死亡率。
除脂质参数外，代谢综合征及其所有成分的患病率随着年龄的增长而显著增加。在<55 岁的参与者中，使用三种不同定义的代谢综合征与全因死亡率显著升高，且不受混杂因素调整的影响。然而，在>65 岁的参与者中，该死亡率从 1.77（1.45-2.16）下降至 1.12（0.84-1.48）[风险比（95%置信区间）；国家胆固醇教育计划定义]。在>65 岁的参与者中，腰围、空腹血糖和脂质参数不能预测死亡率。相比之下，高血压（血压>140/90mmHg 或治疗）仍然是>65 岁参与者全因死亡的重要预测因素[风险比 1.30（95%置信区间 1.02-1.66）]。
在以初级保健为代表的环境中，高血压而不是代谢综合征仍然是>65 岁参与者全因死亡的强有力危险因素。
