Department of Health, Government of Navarre, Vascular Risk in Navarre Investigation Group, Pamplona, Spain.
Dirección General de Salud del Gobierno de Navarra, Servicio de Planificación, Evaluación Y Gestión del Conocimiento, Pamplona, Spain.
Cardiovasc Diabetol. 2020 Nov 22;19(1):195. doi: 10.1186/s12933-020-01166-6.
We aimed to investigate the association of metabolic syndrome (MetS) and its single components with cardiovascular risk and estimated their impact on the prematurity of occurrence of cardiovascular events using rate advancement periods (RAPs).
We performed prospective analyses among 3976 participants (age range: 35-84, 55% female) in the Vascular Risk in Navarre (RIVANA) Study, a Mediterranean population-based cohort. MetS was defined based on the modified criteria of the American Heart Association/National Heart, Lung, and Blood Institute and the International Diabetes Federation. The primary endpoint was major cardiovascular event (a composite of myocardial infarction, stroke, or mortality from cardiovascular causes). Secondary endpoints were incidence of non-fatal myocardial infarction and non-fatal stroke, cardiovascular mortality, and all-cause mortality. Cox proportional hazards models, adjusted for potential confounders, were fitted to evaluate the association between MetS and its single components at baseline with primary and secondary endpoints.
During a median follow-up of 12.8 years (interquartile range, 12.5-13.1), we identified 228 primary endpoint events. MetS was associated with higher risk of incidence of major cardiovascular event, cardiovascular and all-cause mortality, but was neither associated with higher risk of myocardial infarction nor stroke. Compared with participants without MetS, the multivariable hazard ratio (95% confidence interval [CI]) among participants with MetS was 1.32 (1.01-1.74) with RAP (95% CI) of 3.23 years (0.03, 6.42) for major cardiovascular event, 1.64 (1.03-2.60) with RAP of 3.73 years (0.02, 7.45) for cardiovascular mortality, and 1.45 (1.17-1.80) with RAP of 3.24 years (1.21, 5.27) for all-cause mortality. The magnitude of the associations of the single components of MetS was similar than the predicted by MetS. Additionally, for each additional trait of MetS, incidence of major cardiovascular event relatively increased by 22% (1.22, 95% CI 1.09-1.36) with RAP of 2.31 years (0.88, 3.74).
MetS was independently associated with CVD risk, cardiovascular and all-cause mortality. Components of the MetS were associated with similar magnitude of increased CVD, which suggests that MetS was not in excess of the level explained by the presence of its single components. Further research should explore the association of different combinations of the components of MetS with CVD.
本研究旨在通过计算率提前期（RAP），探讨代谢综合征（MetS）及其单一成分与心血管风险的相关性，并评估其对心血管事件发生时间的影响。
本前瞻性研究纳入了 3976 名（年龄 35-84 岁，55%为女性）来自纳瓦拉血管风险研究（RIVANA）的参与者。MetS 定义基于美国心脏协会/美国国立心肺血液研究所和国际糖尿病联合会的改良标准。主要终点为主要心血管事件（心肌梗死、卒中和心血管原因导致的死亡率的复合终点）。次要终点为非致死性心肌梗死和非致死性卒中等心血管事件的发生率、心血管死亡率和全因死亡率。采用 Cox 比例风险模型，调整潜在混杂因素，评估基线时 MetS 及其各成分与主要和次要终点之间的相关性。
中位随访 12.8 年（四分位间距 12.5-13.1）期间，共发生 228 例主要终点事件。MetS 与较高的主要心血管事件、心血管和全因死亡率风险相关，但与心肌梗死或卒中等心血管事件风险增加无关。与无 MetS 的参与者相比，有 MetS 的参与者的多变量风险比（95%置信区间 [CI]）为 1.32（1.01-1.74），主要心血管事件的 RAP（95%CI）为 3.23 年（0.03，6.42），心血管死亡率的 RAP 为 3.73 年（0.02，7.45），全因死亡率的 RAP 为 3.24 年（1.21，5.27）。MetS 各成分的相关性强度与 MetS 预测的相似。此外，每增加一个 MetS 成分，主要心血管事件的发生率相对增加 22%（1.22，95%CI 1.09-1.36），RAP 为 2.31 年（0.88，3.74）。
MetS 与 CVD 风险、心血管和全因死亡率独立相关。MetS 的各成分与 CVD 风险的增加呈相似的相关性，这表明 MetS 并非超过其单个成分的解释水平。进一步的研究应探索 MetS 各成分的不同组合与 CVD 之间的关联。
