Metabolic syndrome and cardiovascular disease in older people: The cardiovascular health study
Ann Marie McNeill1, Ronit Katz, Cynthia J Girman
1Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27514, USA. am_mcneill@alumni.unc.edu
Insights
Metabolic syndrome (MetS) is linked to increased cardiovascular disease (CVD) risk in older adults. Recognizing and treating MetS components, especially high blood pressure, is crucial for prevention.
Area of Science:
- Gerontology
- Cardiology
- Endocrinology
Background:
- Metabolic syndrome (MetS) is a cluster of conditions that increase the risk of heart disease, stroke, and diabetes.
- Previous studies have primarily focused on middle-aged populations, with limited data on older adults.
Purpose of the Study:
- To prospectively examine the association between MetS and cardiovascular disease (CVD) in an elderly cohort.
- To evaluate the impact of a lower impaired fasting glucose (IFG) threshold on MetS prevalence and CVD risk.
Main Methods:
- A prospective cohort study involving 3,585 participants (mean age 72) from the Cardiovascular Health Study.
- MetS was defined using original (2001) and revised (2005) criteria, with the latter incorporating a lower IFG threshold (5.6-6.9 mmol/L).
- Incident CVD events (coronary heart disease, stroke, congestive heart failure) were adjudicated over a median follow-up of 11 years.
Main Results:
- MetS was associated with a 20-30% increased likelihood of any CVD event in older adults.
- Lowering the IFG threshold nearly tripled IFG prevalence and reclassified an additional 9% of participants into the MetS group.
- High blood pressure emerged as the MetS component most strongly linked to incident coronary heart disease.
Conclusions:
- The findings support the link between MetS and CVD development in older populations.
- Early recognition and management of MetS components, particularly hypertension, are vital for CVD prevention in the elderly.
Objectives:
To assess the prospective association between metabolic syndrome (MetS) and cardiovascular disease (CVD) in older people and to evaluate the effect of lowering the threshold for impaired fasting glucose (IFG) on the prevalence of IFG and MetS and the risk of CVD.
Design:
Prospective cohort study.
Setting:
Four field centers in U.S. communities.
Participants:
Three thousand five hundred eighty-five subjects in the Cardiovascular Health Study free of diabetes mellitus and CVD at baseline (mean age 72, 62% female, 14% black).
Measurements:
Baseline measures of MetS components and adjudicated incident CVD events. MetS (2001) was defined first using the original criteria from the Third Adult Treatment Panel Report of the National Cholesterol Education Program (> or =3 of the following: large waist circumference (women >88 cm, men >102 cm), elevated triglycerides (> or =1.70 mmol/L), low high-density lipoprotein cholesterol (men <1.04 mmol/L, women <1.30 mmol/L), elevated fasting glucose (6.1-6.9 mmol/L), and high blood pressure (> or =130/85 mmHg or self-reported use of medications for hypertension). Subjects were also classified according to the revised definition of the MetS (2005) that applies the lower threshold for fasting glucose (5.6-6.9 mmol/L).
Results:
During follow-up (median 11 years), 818 coronary heart disease (CHD), 401 stroke, and 554 congestive heart failure (CHF) events occurred. Age- and race-adjusted hazard ratios (HRs) for CHD, stroke, and CHF were 1.30 (95% confidence interval (CI) = 1.07-1.57), 0.94 (95% CI = 0.73-1.21), and 1.40 (95% CI = 1.12-1.76) for women and 1.35 (95% CI = 1.10-1.66), 1.51 (95% CI = 1.08-2.12), and 1.47 (95% CI = 1.14-1.90) for men, respectively. Overall, women and men with MetS (2005) were 20% to 30% more likely to experience any CVD event than subjects without MetS (2005). Using the lower cut-point for IFG resulted in a near tripling in IFG prevalence (16% to 46%) and an additional 9% classified with MetS (2005) but HRs similar to those estimated from the original MetS (2001) criteria. High blood pressure was the component most strongly associated with incident CHD.
Conclusion:
Results from this study of an elderly, population-based cohort provide support for earlier investigations in primarily middle-aged populations that link the presence of MetS with the development of CVD and further underscore the importance of recognizing and treating its individual components, particularly high blood pressure.
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