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Risk of cardiovascular events in patients with metabolic syndrome: Results of a population-based prospective cohort study (PURE Turkey) [Anatol J Cardiol]
Anatol J Cardiol. 2020; 24(3): 192-200 | DOI: 10.14744/AnatolJCardiol.2020.27227  

Risk of cardiovascular events in patients with metabolic syndrome: Results of a population-based prospective cohort study (PURE Turkey)

Aytekin Oğuz1, Mustafa Kılıçkap2, Sadi Güleç2, Yüksel Altuntaş3, Kubilay Karşıdağ4, Ahmet Temizhan5, Burcu Çalık Tümerdem6, Miraç Vural Keskinler1, Sumathy Rangarajan7, Salim Yusuf7
1Department of Internal Medicine, Faculty of Medicine, İstanbul Medeniyet University; İstanbul-Turkey
2Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
3Clinic of Endocrinology and Metabolism, Faculty of Medicine, University of Health Sciences, İstanbul Şişli Hamidiye Etfal Health Training and Research Hospital; İstanbul-Turkey
4Department of Internal Medicine, Division of Endocrinology, Faculty of Medicine, İstanbul University; İstanbul-Turkey
5Clinic of Cardiology, University of Health Science, Ankara City Hospital; Ankara-Turkey
6Department of Health Administration, Marmara University Faculty of Health Sciences; İstanbul-Turkey
7Population Health Research Institute, McMaster University and Hamilton Health Sciences; Hamilton, ON-Canada

Objective: Metabolic syndrome (MetS) includes several cardiovascular (CV) risk factors. This study aimed to assess CV risk of MetS, contribution of its components to the risk, and whether MetS provides additional risk beyond its components.
Methods: The Prospective Urban Rural Epidemiology (PURE) Turkey cohort included 3933 individuals aged between 35 and 70 years, with a median follow-up of 8.9 years. MetS was diagnosed as the presence of any of the following criteria: high blood pressure, high fasting plasma glucose, abdominal obesity, low HDL-cholesterol, or high triglycerides. The primary outcome was the composite of fatal CV events, non-fatal myocardial infarction, stroke or heart failure, adjusted for age, sex, smoking, family history of CV diseases, and LDL-cholesterol.
Results: The primary outcome was more common in the MetS group [178 (9.2%) vs. 70 (3.5%); corresponding incidence rate of 11.3 vs. 4.2 per 1000 person-years; log-rank p<0.001]. Each component was significantly associated with the primary outcome; however, when the components were sequentially included in the model, abdominal obesity and high triglycerides did not provide additional risk on top of the other three components. The hazard ratio for MetS for the primary outcome was 2.12 (95% confidence interval 1.59–2.81, p<0.001), and the discriminative ability (c-statistics) of the models with MetS and the components was similar.
Conclusion: MetS increases the risk of CV events more than two-fold. High blood pressure, high fasting plasma glucose, and low HDL-cholesterol are the top three components of MetS for CV risk. MetS and its components have a similar discriminative ability for CV events.

Keywords: metabolic syndrome, cardiovascular diseases, mortality, cohort study


Aytekin Oğuz, Mustafa Kılıçkap, Sadi Güleç, Yüksel Altuntaş, Kubilay Karşıdağ, Ahmet Temizhan, Burcu Çalık Tümerdem, Miraç Vural Keskinler, Sumathy Rangarajan, Salim Yusuf. Risk of cardiovascular events in patients with metabolic syndrome: Results of a population-based prospective cohort study (PURE Turkey). Anatol J Cardiol. 2020; 24(3): 192-200

Corresponding Author: Aytekin Oğuz, Türkiye


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