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. 2009 Jul;32(7):1289-94.
doi: 10.2337/dc08-1871. Epub 2009 Apr 14.

Metabolic Syndrome and Diabetes, Alone and in Combination, as Predictors of Cardiovascular Disease Mortality Among Men

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Metabolic Syndrome and Diabetes, Alone and in Combination, as Predictors of Cardiovascular Disease Mortality Among Men

Timothy S Church et al. Diabetes Care. .
Free PMC article


Objective: To examine cardiovascular disease (CVD) mortality risk in men with diabetes only, metabolic syndrome only, and concurrent metabolic syndrome and diabetes.

Research design and methods: We examined CVD mortality risk by metabolic syndrome and diabetes status in men from the Aerobics Center Longitudinal Study (ACLS) (mean +/- SD age 45.1 +/- 10.2 years). Participants were categorized as having neither diabetes nor metabolic syndrome (n = 23,770), metabolic syndrome only (n = 8,780), diabetes only (n = 532), or both (n = 1,097). The duration of follow-up was 14.6 +/- 7.0 years with a total of 483,079 person-years of exposure and 1,085 CVD deaths.

Results: Age-, examination year-, and smoking-adjusted CVD death rates (per 1,000 man-years) in men with neither metabolic syndrome nor diabetes, metabolic syndrome only, diabetes only, and both were 1.9, 3.3, 5.5, and 6.5, respectively. CVD mortality was higher in men with metabolic syndrome only (hazard ratio 1.8 [95% CI 1.5-2.0]), diabetes only (2.9 [2.1-4.0]), and both (3.4 [2.8-4.2]) compared with men with neither. The presence of metabolic syndrome was not associated (1.2 [0.8-1.7]) with higher CVD mortality risk in individuals with diabetes. In contrast, the presence of diabetes substantially increased (2.1 [1.7-2.6]) CVD mortality risk in individuals with metabolic syndrome.

Conclusions: The presence of diabetes was associated with a threefold higher CVD mortality risk, and metabolic syndrome status did not modify this risk. Our findings support the fact that physicians should be aggressive in using CVD risk-reducing therapies in all diabetic patients regardless of metabolic syndrome status.


Figure 1
Figure 1
Data from the combined cohort of 34,179 men with 1,085 CVD deaths. Curves represent age- and smoking-adjusted survival rates with individuals categorized by diabetes (DM) and metabolic syndrome (MS) status: neither, MS only, DM only, or MS & DM.
Figure 2
Figure 2
The risk of CVD mortality associated with having metabolic syndrome only, diabetes only, or both with the reference group being individuals free of metabolic syndrome or diabetes (neither) is depicted. Cox proportional hazards models were used to estimate age, examination year, and smoking-adjusted hazard ratios (bottom panel) and CVD mortality rates as deaths/1,000 man-years of follow-up (top panel). The error bars represent the 95% CIs.

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