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Metabolic syndrome and all-cause mortality: a meta-analysis of prospective cohort studies

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An Erratum to this article was published on 11 August 2010

Abstract

To synthesize the available data on the association between metabolic syndrome and all-cause mortality, we conducted a meta-analysis of prospective cohort studies. We performed a literature search using Medline, EMBASE and Cochrane Library from 2001 to December 2009, with no restrictions. We included studies if they were prospective, had an assessment of metabolic syndrome at baseline and risk of all-cause mortality. We recorded several characteristics for each study. We extracted relative risks (RR) and 95% confidence intervals (CI) and pooled them using fixed or random effects models. We performed sensitivity analysis, and assessed heterogeneity and publication bias. A total of 21 studies including 372,411 participants were included in our meta-analysis. 18,556 deaths from any cause occurred during a mean follow-up of 11.5 years. Individuals with the metabolic syndrome, compared to those without, had an increased mortality from all causes (pooled RR 1.46; 95% CI 1.35–1.57). The RR of all-cause mortality associated with metabolic syndrome was higher in studies using the National Cholesterol Education Program Adult Treatment Panel (NCEP) than the revised NCEP criteria (RR: 1.45 vs. 1.25; P = 0.0002). Metabolic syndrome is an important risk factor for all-cause mortality. The diagnosis and treatment of the underlying risk factors for the metabolic syndrome should be an important strategy for the reduction of all-cause mortality associated with metabolic syndrome in the general population.

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Abbreviations

BMI:

Body mass index

BP:

Blood pressure

CI:

Confidence interval

CHD:

Coronary heart disease

CVD:

Cardiovascular disease

HR:

Hazard ratio

LDL:

Low-density-lipoprotein

MetS:

Metabolic syndrome

NCEP:

The National Cholesterol Education Program Adult Treatment Panel III

NCEP-R:

Revised NCEP

RR:

Relative risk

WC:

Waist circumference

WHO:

World Health Organization

References

  1. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595–607.

    Article  CAS  PubMed  Google Scholar 

  2. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. adults. Diabetes Care. 2004;27(10):2444–9.

    Article  PubMed  Google Scholar 

  3. Ko GT, Cockram CS, Chow CC, et al. High prevalence of metabolic syndrome in Hong Kong Chinese—comparison of three diagnostic criteria. Diabetes Res Clin Pract. 2005;69(2):160–8.

    Article  PubMed  Google Scholar 

  4. James PT, Rigby N, Leach R. International obesity task force. The obesity epidemic, metabolic syndrome and future prevention strategies. Eur J Cardiovasc Prev Rehabil. 2004;11(1):3–8.

    Article  PubMed  Google Scholar 

  5. Jorgensen ME, Borch-Johnsen K. The metabolic syndrome—is one global definition possible? Diabet Med. 2004;21(10):1064–5.

    Article  PubMed  Google Scholar 

  6. American Diabetes Association. Consensus development conference on insulin resistance, November 5–6, 1997. Diabetes Care. 1998;21(2):310–4.

    Google Scholar 

  7. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO Consultation. Part 1: diagnosis and classification of diabetes mellitus. Geneva: World Health Organization, 1999 (WHO/NCD/NCS99.2).

  8. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486–97.

    Article  Google Scholar 

  9. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735–52.

    Article  PubMed  Google Scholar 

  10. Galassi A, Reynolds K, He J. Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med. 2006;119(10):812–9.

    Article  CAS  PubMed  Google Scholar 

  11. Hu G, Qiao Q, Tuomilehto J, et al. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med. 2004;164(10):1066–76.

    Article  PubMed  Google Scholar 

  12. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.

    Article  CAS  PubMed  Google Scholar 

  13. Egger M, Juni P, Bartlett C, Holenstein F, Sterne J. How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technol Assess. 2003;7(1):1–76.

    CAS  PubMed  Google Scholar 

  14. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  PubMed  Google Scholar 

  15. Deeks JJ, Altman DG. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DG, editors. Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ Publication Group; 2001. p. 285–312.

    Google Scholar 

  16. Trevisan M, Liu J, Bahsas FB, Menotti A. Syndrome X and mortality: a population-based study. Risk factor and life expectancy research group. Am J Epidemiol. 1998;148(10):958–66.

    CAS  PubMed  Google Scholar 

  17. Tsai SP, Wen CP, Chan HT, Chiang PH, Tsai MK, Cheng TY. The effects of pre-disease risk factors within metabolic syndrome on all-cause and cardiovascular disease mortality. Diabetes Res Clin Pract. 2008;82(1):148–56.

    Article  PubMed  Google Scholar 

  18. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    CAS  PubMed  Google Scholar 

  19. Rosenthal R. The “file drawer problem” and tolerance for null results. Psychol Bull. 1979;86:638–41.

    Article  Google Scholar 

  20. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63.

    Article  CAS  PubMed  Google Scholar 

  21. Bax L, Yu LM, Ikeda N, Tsuruta H, Moons KG. Development and validation of MIX: Comprehensive free software for meta-analysis of causal research data. BMC Med Res Methodol. 2006;6:50.

    Article  PubMed  Google Scholar 

  22. Bax L, Yu LM, Ikeda N, Moons KG. A systematic comparison of software dedicated to meta-analysis of causal studies. BMC Med Res Methodol. 2007;7:40.

    Article  PubMed  Google Scholar 

  23. Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288(21):2709–16.

    Article  PubMed  Google Scholar 

  24. Katzmarzyk PT, Church TS, Janssen I, Ross R, Blair SN. Metabolic syndrome, obesity, and mortality: impact of cardiorespiratory fitness. Diabetes Care. 2005;28(2):391–7.

    Article  PubMed  Google Scholar 

  25. Sundstrom J, Riserus U, Byberg L, Zethelius B, Lithell H, Lind L. Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality: prospective, population based cohort study. BMJ. 2006;332(7546):878–82.

    Article  PubMed  Google Scholar 

  26. Dekker JM, Girman C, Rhodes T, et al. Metabolic syndrome and 10-year cardiovascular disease risk in the Hoorn study. Circulation. 2005;112(5):666–73.

    Article  PubMed  Google Scholar 

  27. Tanomsup S, Aekplakorn W, Sritara P, et al. A comparison of components of two definitions of the metabolic syndrome related to cardiovascular disease and all-cause mortality in a cohort study in Thailand. Diabetes Care. 2007;30(8):2138–40.

    Article  PubMed  Google Scholar 

  28. Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP. San Antonio Heart Study. National cholesterol education program versus world health organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study. Circulation. 2004;110(10):1251–7.

    Article  PubMed  Google Scholar 

  29. Benetos A, Thomas F, Pannier B, Bean K, Jego B, Guize L. All-cause and cardiovascular mortality using the different definitions of metabolic syndrome. Am J Cardiol. 2008;102(2):188–91.

    Article  PubMed  Google Scholar 

  30. Thomas GN, Schooling CM, McGhee SM, et al. Metabolic syndrome increases all-cause and vascular mortality: The Hong Kong cardiovascular risk factor study. Clin Endocrinol (Oxf). 2007;66(5):666–71.

    Article  Google Scholar 

  31. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation. 2002;106(25):3143–421.

    Google Scholar 

  32. Hsu PF, Chuang SY, Cheng HM, Tsai ST, Chou P, Chen CH. Clinical significance of the metabolic syndrome in the absence of established hypertension and diabetes: a community-based study. Diabetes Res Clin Pract. 2008;79(3):461–7.

    Article  CAS  PubMed  Google Scholar 

  33. Niwa Y, Ishikawa S, Gotoh T, Kayaba K, Nakamura Y, Kajii E. Metabolic syndrome mortality in a population-based cohort study: Jichi Medical School (JMS) Cohort Study. J Epidemiol. 2007;17(6):203–9.

    Article  PubMed  Google Scholar 

  34. Lee J, Heng D, Ma S, Chew SK, Hughes K, Tai ES. The metabolic syndrome and mortality: the Singapore cardiovascular cohort study. Clin Endocrinol (Oxf). 2008;69(2):225–30.

    Article  Google Scholar 

  35. Simons LA, Simons J, Friedlander Y, McCallum J. Does a diagnosis of the metabolic syndrome provide additional prediction of cardiovascular disease and total mortality in the elderly? The Dubbo study. Med J Aust. 2007;186(8):400–3.

    PubMed  Google Scholar 

  36. Malik S, Wong ND, Franklin SS, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004;110(10):1245–50.

    Article  PubMed  Google Scholar 

  37. Otiniano ME, Du XL, Maldonado MR, Ray L, Markides K. Effect of metabolic syndrome on heart attack and mortality in Mexican American elderly persons: findings of 7-year follow-up from the Hispanic established population for the epidemiological study of the elderly. J Gerontol A Biol Sci Med Sci. 2005;60(4):466–70.

    PubMed  Google Scholar 

  38. Ravaglia G, Forti P, Maioli F, et al. Metabolic syndrome: prevalence and prediction of mortality in elderly individuals. Diabetes Care. 2006;29(11):2471–6.

    Article  CAS  PubMed  Google Scholar 

  39. Hong Y, Jin X, Mo J, et al. Metabolic syndrome, its preeminent clusters, incident coronary heart disease and all-cause mortality—results of prospective analysis for the atherosclerosis risk in communities study. J Intern Med. 2007;262(1):113–22.

    Article  CAS  PubMed  Google Scholar 

  40. Huang KC, Lee LT, Chen CY, Sung PK. All-cause and cardiovascular disease mortality increased with metabolic syndrome in Taiwanese. Obesity (Silver Spring). 2008;16(3):684–9.

    Article  Google Scholar 

  41. Mozaffarian D, Kamineni A, Prineas RJ, Siscovick DS. Metabolic syndrome and mortality in older adults: The Cardiovascular Health Study. Arch Intern Med. 2008;168(9):969–78.

    Article  PubMed  Google Scholar 

  42. Zambon S, Zanoni S, Romanato G, et al. Metabolic syndrome and all-cause and cardiovascular mortality in an Italian elderly population: The Progetto Veneto Anziani (PRO.V.A.) Study. Diabetes Care. 2009;32(1):153–9.

    Article  PubMed  Google Scholar 

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Author contributions

Dr. Wu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Ho, Wu, Liu; Acquisition of data: Wu, Liu; Analysis and interpretation of data: Wu, Ho, Liu; Drafting of the manuscript: Wu; Critical revision of the manuscript for important intellectual content: Ho, Liu; Statistical analysis: Wu, Liu; Administrative, technical, or material support: Ho, Wu; Study supervision: Ho, Wu.

Author information

Authors and Affiliations

  1. School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, People’s Republic of China

    Wu Sheng Hui

  2. Nanjing Maternal and Child Health Care Hospital, Nanjing City, People’s Republic of China

    Wu Sheng Hui

  3. Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, People’s Republic of China

    Zhong Liu

  4. School of Basic Medical Science, Southeast University, Nanjing, People’s Republic of China

    Zhong Liu

  5. 4/F, School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, People’s Republic of China

    Suzanne C. Ho

Authors
  1. Wu Sheng Hui
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  2. Zhong Liu
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  3. Suzanne C. Ho
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Corresponding author

Correspondence to Suzanne C. Ho.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s10654-010-9496-7

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Hui, W.S., Liu, Z. & Ho, S.C. Metabolic syndrome and all-cause mortality: a meta-analysis of prospective cohort studies. Eur J Epidemiol 25, 375–384 (2010). https://doi.org/10.1007/s10654-010-9459-z

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  • DOI: https://doi.org/10.1007/s10654-010-9459-z

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