The metabolic syndrome and mortality: the Singapore Cardiovascular Cohort Study
Jeannette Lee1, Derrick Heng, Stefan Ma
1Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. cofleejm@nus.edu.sg
Insights
Metabolic syndrome increases all-cause and cardiovascular disease mortality risk in healthy Asian adults. However, the Framingham risk score better predicts mortality than metabolic syndrome in this population.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes.
- Assessing the predictive utility of metabolic syndrome for mortality is crucial for public health interventions.
Purpose of the Study:
- To evaluate the impact of metabolic syndrome on all-cause and cardiovascular disease (CVD) mortality in a multi-ethnic Asian population in Singapore.
- To compare the predictive performance of the metabolic syndrome with the Framingham risk score for mortality.
Main Methods:
- A cohort of 5699 healthy participants was followed for a mean of 14.1 years.
- Mortality risk was analyzed using Cox's proportional hazards models and adjusted hazard ratios (HRs).
- Receiver operating characteristic (ROC) curves were used to compare the predictive accuracy of metabolic syndrome and the Framingham risk score.
Main Results:
- Metabolic syndrome was associated with increased all-cause mortality in both males (HR 1.4) and females (HR 1.8).
- Individuals with metabolic syndrome had a significantly higher risk of CVD mortality (males: HR 3.0; females: HR 2.1).
- The Framingham risk score demonstrated superior predictive performance for both all-cause and CVD mortality compared to the metabolic syndrome.
Conclusions:
- While metabolic syndrome is linked to elevated mortality, the Framingham risk score offers better predictive accuracy in this Asian cohort.
- Metabolic syndrome remains a valuable clinical tool for identifying individuals requiring management of cardiovascular risk factors.
Objective:
This study assesses the effect of the metabolic syndrome on all-cause and cardiovascular disease (CVD) mortality in healthy Chinese, Malays and Asian Indians in Singapore. The utility of the metabolic syndrome is also compared with the Framingham risk score for prediction of mortality.
Methods:
Healthy participants (n = 5699) were grouped by the presence or absence of the metabolic syndrome, and followed up (mean 14.1 years) by data linkage with the National Death Register. Risk of mortality was obtained by Cox's proportional hazards model with adjusted hazard ratios (HRs). Area under receiver operating characteristic (ROC) curves were used to compare the metabolic syndrome and Framingham risk score for prediction of mortality.
Results:
During a follow-up of 80,236 person-years, there were 382 deaths, of which 128 were due to CVD. Individuals with the metabolic syndrome had an increased risk of mortality for 'all-causes' (males: HR 1.4, 95% confidence intervals (95%CI) 1.1-1.8; and females: HR 1.8, 95%CI 1.3-2.6). There was also an increased risk of mortality due to CVD (males: HR 3.0, 95%CI 1.9-4.8; and females: HR 2.1, 95%CI 1.1-4.0). The area under ROC for Framingham risk score was higher for both all-cause and CVD mortality than metabolic syndrome.
Conclusions:
Although an increased risk of 'all-cause' and CVD mortality due to the metabolic syndrome was found, the Framingham risk function still performed better than the metabolic syndrome in an Asian population. However, the metabolic syndrome should not be disregarded as it is a clinically useful entity for identifying individuals for management of its component CVD risk factors.
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