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AM McNeill, WD Rosamond, CM Ballantyne,
University of North Carolina, Chapel Hill
In May 2001, the National Cholesterol Education Program (NCEP III)
proposed a definition for the metabolic syndrome, a term describing
a cluster of disorders related to insulin resistance and excess
coronary heart disease. The NCEP definition consists of dichotomous
measures for elevated blood pressure, glucose intolerance, high
triglycerides, low HDL, and abdominal obesity and requires the presence
of at least three of these five components. The objective of this
study was to determine the prevalence of the syndrome using the
NCEP definition and to estimate the risk associated with incident
CHD in a population-based cohort. Using baseline data on 14,781
individuals aged 45 to 64 years from the Atherosclerosis Risk in
Communities Study (ARIC), we examined the prevalence of the metabolic
syndrome at the baseline visit (1987-1989). Cox proportional hazards
regression was used to estimate the association between the metabolic
syndrome and 10-year risk of CHD among 13,046 cohort members free
of CHD at baseline. Nearly a third of the men (30%) and women (32%)
in the ARIC cohort met the NCEP criteria for the metabolic syndrome
at baseline. Black women had the highest prevalence (39%) followed
by white men (32%), white women (30%), and black men (26%). The
10-year incidence of CHD among individuals with the syndrome was
twice that among those without the syndrome (11.7% vs. 5.8%, p <0.001).
After adjustment for age, sex, race by ARIC center, smoking, education,
family income, and LDL, the hazard ratio for individuals with the
metabolic syndrome was 2.40 (95% CI: 1.81-3.20) for women and 1.84
(95% CI: 1.51-2.25) for men. The definition of the metabolic syndrome
proposed by NCEP identifies individuals at increased risk for CHD.
Given that widespread adoption of this definition in clinical practice
is likely, further research is needed to determine how this definition
of the metabolic syndrome can be integrated into primary prevention
efforts.
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