National Cholesterol Education Program Versus World Health Organization Metabolic Syndrome in Relation to All-Cause and Cardiovascular Mortality in the San Antonio Heart Study
Abstract
Background— To assess the utility of clinical definitions of the metabolic syndrome (MetS) to identify individuals with increased cardiovascular risk, we examined the relation between the MetS, using both the National Cholesterol Education Program (NCEP) and the World Health Organization definitions, and all-cause and cardiovascular mortality in San Antonio Heart Study participants enrolled between 1984 and 1988. Methods and Results— Among 2815 participants, 25 to 64 years of age at enrollment, 509 met both criteria, 197 met NCEP criteria only, and 199 met WHO criteria only. Over an average of 12.7 years, 229 deaths occurred (117 from cardiovascular disease). Moreover, in the primary prevention population of 2372 participants (ie, those without diabetes or cardiovascular disease at baseline), 132 deaths occurred (50 from cardiovascular disease). In the primary prevention population, the only significant association adjusted for age, gender, and ethnic group was between NCEP-MetS and cardiovascular mortality (hazard ratio [HR], 2.01; 95% CI, 1.13–3.57). In the general population, all-cause mortality HRs were 1.47 (95% CI, 1.13–1.92) for NCEP-MetS and 1.27 (95% CI, 0.97–1.66) for WHO-MetS. Furthermore, for cardiovascular mortality, there was evidence that gender modified the predictive ability of the MetS. For women and men, respectively, HRs for NCEP-MetS were 4.65 (95% CI, 2.35–9.21) and 1.82 (95% CI, 1.14–2.91), whereas HRs for WHO-MetS were 2.83 (95% CI, 1.55–5.17) and 1.15 (95% CI, 0.72–1.86). Conclusions— In summary, although both definitions were predictive in the general population, the simpler NCEP definition tended to be more predictive in lower-risk subjects.
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Metabolic syndrome is a condition that poses a high risk for the development of cardiovascular disease.
“[Statement]Metabolic syndrome is a condition that poses a high risk for the development of cardiovascular disease (Evidence level: E-1b).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [323]
Conditions such as metabolic syndrome that involve the clustering of multiple risk factors have been shown to increase the risk of cardiovascular diseases in epidemiological studies and meta-analyses, as well as in CIRCS study, Tanno and Sobetsu study, and Hisayama study.
“Conditions, such as metabolic syndrome, that involve the clustering of multiple risk factors have been shown to increase the risk of cardiovascular diseases in epidemiological studies323–326) and meta-analyses327), as well as in CIRCS study78), the Tanno and Sobetsu study328) and the Hisayama study317).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [323]
Metabolic syndrome is significant because it is a high risk of ASCVD even if the levels of hyperglycemia, dyslipidemia and elevated blood pressure are relatively mild.
“Metabolic syndrome is significant because it is a high risk of ASCVD even if the levels of hyperglycemia, dyslipidemia and elevated blood pressure are relatively mild323–327).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [323]
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- Authors
- Hunt, K. J., Resendez, R. G., Williams, K., Haffner, S. M., & Stern, M. P.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- From the Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
- ORCID
- Hunt, Kelly J.
- Venue
- Circulation
- Published
- 2004-09-07
- Volume
- 110
- Issue
- 10
- Pages
- 1251-1257
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1999223458
- Cited by
- 662
- References
- 19
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 7 · 2023: 8 · 2022: 6 · 2021: 11 · 2020: 16 · 2019: 10 · 2018: 18 · 2017: 14 · 2016: 23 · 2015: 20 · 2014: 32 · 2013: 28 · 2012: 42
- FWCI
- 48.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Diabetes Association
- American Heart Association
- National Heart, Lung, and Blood Institute (R01 HL 36820, R01HL024799, R01HL036820, R01HL24799, T32HL007446, T32-HL07446)
- National Institute of Diabetes and Digestive and Kidney Diseases (K01DK064867)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- metabolic syndrome, NCEP criteria, WHO criteria, cardiovascular mortality, all-cause mortality, cardiovascular risk prediction, San Antonio Heart Study, primary prevention, sex differences, diagnostic criteria comparison
- MeSH terms
- Adult, Albuminuria, Cardiovascular Diseases, Female, Humans, Hyperglycemia, Hyperinsulinism, Hyperlipidemias, Insulin Resistance, Male, Middle Aged, Mortality, National Health Programs, Terminology as Topic, Obesity, Patient Education as Topic, Surveys and Questionnaires, Risk Factors, Texas, World Health Organization, Cohort Studies, Comorbidity, Proportional Hazards Models, Mexican Americans, Metabolic Syndrome, Diabetes Complications
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