Impact of Age and Gender on the Prevalence and Prognostic Importance of the Metabolic Syndrome and Its Components in Europeans. The MORGAM Prospective Cohort Project

Q: What are the key findings of this study?

Metabolic syndrome increased coronary heart disease risk in men and women, with relative CHD risk declining with age in women.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Metabolic Syndrome and Cardiovascular Disease risk (n=69094). Intervention: Metabolic Syndrome (IDF and NCEP-ATP III criteria) vs. Absence of Metabolic Syndrome. Primary outcome: Fatal and nonfatal coronary heart disease (NCEP-ATP III criteria in women) (HR 2.03, 95% CI 1.80-2.29, p=<0.0001).

Q: What does this research mean for the field?

Metabolic syndrome significantly increases coronary heart disease and cardiovascular disease risk in men and women, but its relative CHD risk declines with advancing age in women. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Q: What question did this study set out to answer?

To examine how age and gender alter the prevalence of metabolic syndrome and its associated risk of cardiovascular disease in European populations.

Julie K.K. Vishram; Anders Borglykke; Anne Helms Andreasen; Jørgen Jeppesen; Hans Ibsen; Torben Jørgensen; Luigi Palmieri; Simona Giampaoli; Chiara Donfrancesco; Frank Kee; Giuseppe Mancia; Giancarlo Cesana; Kari Kuulasmaa; Veikko V Salomaa; Susana Sans; Jean Ferrières; Jean Dallongeville; Stefan Söderberg; Dominique Arveiler; Aline Wagner; Hugh Tunstall‐Pedoe; Wojciech Drygas; Michael Hecht Olsen

doi:10.1371/journal.pone.0107294

Key result

Metabolic syndrome is linked to ~2-fold higher coronary heart disease risk in women.

HR 2.03
95% CI 1.80-2.29
P<0.0001
n=69,094

Why the study?

The influence of age and gender on the prevalence and cardiovascular disease risk of the Metabolic Syndrome in Europeans required investigation.

Key Points

To examine how age and gender alter the prevalence of metabolic syndrome and its associated risk of cardiovascular disease in European populations.
Prospective cohort analysis of 69,094 men and women aged 19–78 years without baseline cardiovascular disease across 36 cohorts from the MORGAM Project.
Participants were tracked over an average of 12.2 years to assess fatal and nonfatal coronary heart disease, stroke, and cardiovascular mortality using multivariate-adjusted Cox regressions.
Metabolic syndrome prevalence increased significantly with age (P<0.0001), rising 5-fold in women from ages 19–39 to 60–78 years (7.4% to 35.4% by IDF; 7.6% to 37.6% by NCEP-ATPIII) and 2-fold in men (5.3% to 11.5% by IDF; 10.5% to 21.8% by NCEP-ATPIII).
Metabolic syndrome was significantly associated with all cardiovascular endpoints (P<0.0001); for IDF and NCEP-ATPIII, hazard ratios in men were 1.60 and 1.62 for coronary heart disease, 1.73 and 1.65 for cardiovascular mortality, and 1.51 and 1.53 for stroke, with risks remaining constant across ages (interaction P>0.05).
In women, hazard ratios for coronary heart disease fell sharply with increasing age from 3.23 to 1.55 for IDF (interaction P=0.01) and from 3.98 to 1.56 for NCEP-ATPIII (interaction P=0.001), while stroke hazard ratios showed an upward trend (interaction P>0.05).

Study Design

Type

Cohort (n=69,094)

Multicenter

Yes

PICO

P

Population

69,094 European adults aged 19-78 years (44.1% female) from 36 cohorts across 10 countries, free of known baseline cardiovascular disease, followed for a mean of 12.2 years.

E

Exposure / Comparator

Metabolic Syndrome (IDF and NCEP-ATP III criteria) vs Absence of Metabolic Syndrome

O

Primary Outcome

Fatal and nonfatal coronary heart disease (NCEP-ATP III criteria in women) — HR 2.03 (1.80-2.29), p=<0.0001

Main Result

Hazard Ratio: 2.03 (95% CI 1.8–2.29)

p-value: p=<0.0001

Limitations

Baseline age distribution differed across the various cohorts
Low statistical power in the youngest age group (19-39 years)
Metabolic syndrome status was assessed only at baseline and could change during follow-up
Plasma glucose data were unavailable, so self-reported diabetes or anti-diabetic drug use was used instead
Body mass index was used instead of waist circumference in the main analyses to maximize sample size
Fasting status prior to blood sampling differed between cohorts
Findings may not generalize to non-Europeans or patients with established cardiovascular disease

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Implication

Metabolic syndrome-associated CHD risk may support closer monitoring in younger women; leaves open whether age-specific interventions modify outcomes in European cohorts.

Abstract

OBJECTIVE: To investigate the influence of age and gender on the prevalence and cardiovascular disease (CVD) risk in Europeans presenting with the Metabolic Syndrome (MetS). METHODS: Using 36 cohorts from the MORGAM-Project with baseline between 1982-1997, 69094 men and women aged 19-78 years, without known CVD, were included. During 12.2 years of follow-up, 3.7%/2.1% of men/women died due to CVD. The corresponding percentages for fatal and nonfatal coronary heart disease (CHD) and stroke were 8.3/3.8 and 3.1/2.5. RESULTS: The prevalence of MetS, according to modified definitions of the International Diabetes Federation (IDF) and the revised National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII), increased across age groups for both genders (P<0.0001); with a 5-fold increase in women from ages 19-39 years to 60-78 years (7.4%/7.6% to 35.4%/37.6% for IDF/NCEP-ATPIII) and a 2-fold increase in men (5.3%/10.5% to 11.5%/21.8%). Using multivariate-adjusted Cox regressions, the associations between MetS and all three CVD events were significant (P<0.0001). For IDF/NCEP-ATPIII in men and women, hazard ratio (HR) for CHD was 1.60/1.62 and 1.93/2.03, for CVD mortality 1.73/1.65 and 1.77/2.06, and for stroke 1.51/1.53 and 1.58/1.77. Whereas in men the HRs for CVD events were independent of age (MetS*age, P>0.05), in women the HRs for CHD declined with age (HRs 3.23/3.98 to 1.55/1.56; MetS*age, P=0.01/P=0.001 for IDF/NCEP-ATPIII) while the HRs for stroke tended to increase (HRs 1.31/1.25 to 1.55/1.83; MetS*age, P>0.05). CONCLUSION: In Europeans, both age and gender influenced the prevalence of MetS and its prognostic significance. The present results emphasise the importance of being critical of MetS in its current form as a marker of CVD especially in women, and advocate for a redefinition of MetS taking into account age especially in women.

Discussion

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Cite This Study

Vishram et al. (2014) conducted a cohort in Metabolic Syndrome and Cardiovascular Disease risk (n=69,094). Metabolic Syndrome (IDF and NCEP-ATP III criteria) vs. Absence of Metabolic Syndrome was evaluated on Fatal and nonfatal coronary heart disease (NCEP-ATP III criteria in women) (HR 2.03, 95% CI 1.80-2.29, p=<0.0001). Metabolic syndrome increased coronary heart disease risk in men and women, with relative CHD risk declining with age in women.

synapsesocial.com/papers/6aebffe54cc70ef77e6c8ce5 https://doi.org/10.1371/journal.pone.0107294

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Impact of Age and Gender on the Prevalence and Prognostic Importance of the Metabolic Syndrome and Its Components in Europeans. The MORGAM Prospective Cohort Project

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of Age and Gender on the Prevalence and Prognostic Importance of the Metabolic Syndrome and Its Components in Europeans. The MORGAM Prospective Cohort Project

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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