The Metabolic Syndrome in Older Individuals: Prevalence and Prediction of Cardiovascular Events The Cardiovascular Health Study* ANGELO SCUTERI, MD, PHD 1,2 SAMER S. NAJJAR, MD 1 CHRISTOPHER H. MORRELL, PHD 1 EDWARD G. LAKATTA, MD 1 OBJECTIVE — The prevalence of the metabolic syndrome, a potent risk factor for cardio- vascular diseases (CVDs), has not been adequately explored in older individuals. Moreover, two sets of criteria have been proposed for the definition of metabolic syndrome, one by the World Health Organization (WHO) and one by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII). We therefore investigated the prevalence of this syndrome in a subgroup of older participants from the Cardiovascular Health Study (CHS) who were free of CVD at baseline. We also compared the prognostic significance of the two definitions of the metabolic syndrome. RESEARCH DESIGN AND METHODS — A total of 2,175 subjects from the CHS who were free of CVD at baseline and not taking antihypertensive or lipid-lowering medications were studied. Prevalence of the metabolic syndrome was assessed with both the WHO and ATPIII criteria. The incidence of coronary or cerebrovascular disease was ascertained during a median follow-up time of 4.1 years. RESULTS — Prevalence of the metabolic syndrome was 28.1% by ATPIII criteria and 21.0% by WHO criteria. The two sets of criteria provided concordant classification for 80.6% of participants. Multivariate Cox propotional hazard models showed that the metabolic syndrome defined with the ATPIII criteria, but not with the WHO criteria, was an independent predictor of coronary or cerebrovascular events and was associated with a 38% increased risk (hazard ratio 1.38 [95% CI 1.06 –1.79], P  0.01). CONCLUSIONS — Prevalence of the metabolic syndrome in older individuals is 21–28% (depending on the definition used). The two sets of criteria have 80% concordance in classifying subjects. As defined by the ATPIII criteria, the metabolic syndrome yields independent prog- nostic information, even after adjusting for traditional cardiovascular risk factors and the indi- vidual domains of the metabolic syndrome. Diabetes Care 28:882– 887, 2005 T he metabolic syndrome is increas- ingly recognized as a risk factor for cardiovascular diseases (CVDs) (1) and cardiovascular mortality (2). Because older individuals are at high risk for CVD (3), an understanding of the scope of the metabolic syndrome in this segment of the population is necessary for the ratio- nal allocation of health care and research resources. However, the prevalence of the metabolic syndrome in older individuals has not been well defined, in part, be- cause these individuals have traditionally been underrepresented in most large epi- demiological studies. Two differing sets of criteria have been put forth for the definition of the metabolic syndrome by international committees: one by the World Health Organization (WHO) (4) and, more re- cently, a related but not identical defini- tion from the National Cholesterol Education Program Expert Panel on De- tection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III (NCEP ATPIII) (5). Therefore, the goals of the present analyses were: 1) to investigate the prev- alence of the metabolic syndrome in a subgroup of older participants in the Car- diovascular Health Study (CHS) who were free of CVD at baseline, 2) to evalu- ate whether the two definitions of the metabolic syndrome (WHO and ATPIII) yield different estimates for the preva- lence of this syndrome, 3) to compare the degree of concordance in the classifica- tion of metabolic syndrome by these two definitions, and 4) to prospectively evaluate the prognostic value of each of these two definitions of the metabolic syndrome. RESEARCH DESIGN AND METHODS — The study subjects were participants in the CHS, a prospective multicenter study of men and women 65 years of age or older, sponsored by the National Heart, Lung, and Blood Institute (6). A detailed description of the recruit- ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● From the 1 Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland; and 2 Unita ` Operativa Geriatria, Istituto Nazionale Ricovero E Cura Anziari, Rome, Italy. Address correspondence and reprint requests to Angelo Scuteri, MD PhD, Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, 5600 Nathan Shock Dr., Baltimore, MD 21224. E-mail: scuteria@mail.nih.gov. Received for publication 26 October 2004 and accepted in revised form 10 January 2005. *A complete list of the participating Cardiovascular Health Study investigators and institutions can be found in the APPENDIX. Abbreviations: AUC, area under the curve; CeVD, cerebrovascular disease; CHD, coronary heart disease; CHS, Cardiovascular Health Study; CVD, cardiovascular disease; IMT, intima-media thickness; NCEP ATPIII, National Cholesterol Education Program Adult Treatment Panel III; WHO, World Health Organi- zation. A table elsewhere in this issue shows conventional and Syste `me International (SI) units and conversion factors for many substances. © 2005 by the American Diabetes Association. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes O R I G I N A L A R T I C L E 882 DIABETES CARE, VOLUME 28, NUMBER 4, APRIL 2005