The severity of the metabolic syndrome increases over time within individuals, independent of baseline metabolic syndrome status and medication use: The Atherosclerosis Risk in Communities Study

Atherosclerosis. 2015 Nov;243(1):278-85. doi: 10.1016/j.atherosclerosis.2015.09.025. Epub 2015 Sep 21.


Background and aims: The severity of the metabolic syndrome (MetS) is linked to future cardiovascular disease. However, it is unclear whether MetS severity increases among individuals followed over time.

Methods: We assessed changes in a sex- and race/ethnicity-specific MetS severity Z-score over a 10-year period (visits 1-4) among 9291 participants of the Atherosclerosis Risk in Communities study cohort. We compared sex- and racial/ethnic subgroups for the rate of change in the MetS severity score and MetS prevalence as assessed using traditional ATP-III MetS criteria. We further examined effects of use of medications for hypertension, diabetes and dyslipidemia.

Results: Over the 10 years of follow-up, MetS severity Z-scores increased in 76% of participants from an overall mean of 0.08 ± 0.77 at baseline to 0.48 ± 0.96 at visit 4 with the greatest progression in scores observed among African-American women. Baseline MetS severity scores predicted the time until ATP-III MetS diagnosis, with a model-predicted 77.5% of individuals with a visit 1 MetS severity score of 0.75 progressing to ATP-III MetS within 10 years. The rate of increase in MetS severity score was higher among those younger at baseline but was independent of baseline MetS status or the use of medications to treat blood pressure, lipids and diabetes.

Conclusion: The severity of metabolic derangements as measured using this MetS severity score increases over time within individuals and predicts diagnosis of ATP-III MetS. These data may have implications for tracking MetS related risk within individuals over time.

Keywords: Cardiovascular disease; Metabolic syndrome x; Minority health; Type 2 diabetes mellitus.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use
  • Atherosclerosis / diagnosis*
  • Atherosclerosis / epidemiology
  • Atherosclerosis / ethnology
  • Black or African American
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / ethnology
  • Disease Progression
  • Ethnicity
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / complications
  • Hypertension / diagnosis
  • Hypertension / epidemiology
  • Hypoglycemic Agents / therapeutic use
  • Male
  • Metabolic Syndrome / diagnosis*
  • Metabolic Syndrome / epidemiology
  • Metabolic Syndrome / ethnology
  • Middle Aged
  • Prevalence
  • Severity of Illness Index
  • White People


  • Antihypertensive Agents
  • Hypoglycemic Agents