Relation of the number of metabolic syndrome risk factors with all-cause and cardiovascular mortality

Am J Cardiol. 2008 Sep 15;102(6):689-92. doi: 10.1016/j.amjcard.2008.05.010. Epub 2008 Jun 26.


The metabolic syndrome (MS) is a constellation of risk factors associated with diabetes and cardiovascular disease. This syndrome consists of at least 3 parameters assessing central obesity, hypertension, high-density lipoprotein cholesterol, triglycerides, and impaired glucose metabolism. Whether persons with 4 or 5 risk factors are at higher risk than those with 3 risk factors is unclear. Also unclear is whether those without the MS but with 1 or 2 risk factors warrant therapy. We assessed cardiovascular and all-cause mortality as a function of the number of these risk factors. We followed 30,365 men for a median follow-up of 13.6 years. During follow-up, 1,449 participants died, 527 from cardiovascular causes. All of the individual parameters defining the MS were significantly associated with both all-cause and cardiovascular mortality (p <0.001). After adjustment for age and the other MS variables, hypertension was the most potent risk factor whereas central obesity and hypertriglyceridemia remained associated with both all-cause and cardiovascular mortality. A highly significant trend was also noted between both all-cause or cardiovascular mortality and the number of risk factors (p <0.001 for trend). Risk increased incrementally, beginning at 1 risk factor for cardiovascular mortality and at 2 risk factors for all-cause mortality. In conclusion, there is a continuum of risk as the number of metabolic syndrome risk factors increases. These findings add to the growing evidence that central obesity can independently and adversely affect health.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • Cardiovascular Diseases / mortality*
  • Cholesterol, HDL / blood
  • Humans
  • Hypertension / epidemiology
  • Hypertriglyceridemia / epidemiology
  • Longitudinal Studies
  • Male
  • Metabolic Syndrome / epidemiology*
  • Middle Aged
  • Obesity / epidemiology
  • Risk Assessment
  • Risk Factors


  • Blood Glucose
  • Cholesterol, HDL