National Cholesterol Education Program Versus World Health Organization Metabolic Syndrome in Relation to All-Cause and Cardiovascular Mortality in the San Antonio Heart Study

TLDR

The study evaluated whether the National Cholesterol Education Program and World Health Organization definitions of metabolic syndrome can identify individuals at increased cardiovascular risk by examining their association with all‑cause and cardiovascular mortality in the San Antonio Heart Study. Researchers analyzed 2,815 participants aged 25–64 from the San Antonio Heart Study, classifying 509 as meeting both definitions, 197 only NCEP, and 199 only WHO, and followed them for an average of 12.7 years to assess mortality outcomes. During follow‑up, 229 deaths (117 cardiovascular) occurred; in the primary‑prevention cohort, only the NCEP definition significantly predicted cardiovascular mortality (HR 2.01), while in the overall population NCEP and WHO definitions were associated with all‑cause mortality (HR 1.47 and 1.27, respectively) and gender modified cardiovascular risk, with NCEP showing stronger associations in women (HR 4.65) than men (HR 1.82).

Abstract

To assess the utility of clinical definitions of the metabolic syndrome (MetS) to identify individuals with increased cardiovascular risk, we examined the relation between the MetS, using both the National Cholesterol Education Program (NCEP) and the World Health Organization definitions, and all-cause and cardiovascular mortality in San Antonio Heart Study participants enrolled between 1984 and 1988.Among 2815 participants, 25 to 64 years of age at enrollment, 509 met both criteria, 197 met NCEP criteria only, and 199 met WHO criteria only. Over an average of 12.7 years, 229 deaths occurred (117 from cardiovascular disease). Moreover, in the primary prevention population of 2372 participants (ie, those without diabetes or cardiovascular disease at baseline), 132 deaths occurred (50 from cardiovascular disease). In the primary prevention population, the only significant association adjusted for age, gender, and ethnic group was between NCEP-MetS and cardiovascular mortality (hazard ratio [HR], 2.01; 95% CI, 1.13-3.57). In the general population, all-cause mortality HRs were 1.47 (95% CI, 1.13-1.92) for NCEP-MetS and 1.27 (95% CI, 0.97-1.66) for WHO-MetS. Furthermore, for cardiovascular mortality, there was evidence that gender modified the predictive ability of the MetS. For women and men, respectively, HRs for NCEP-MetS were 4.65 (95% CI, 2.35-9.21) and 1.82 (95% CI, 1.14-2.91), whereas HRs for WHO-MetS were 2.83 (95% CI, 1.55-5.17) and 1.15 (95% CI, 0.72-1.86).In summary, although both definitions were predictive in the general population, the simpler NCEP definition tended to be more predictive in lower-risk subjects.