Atherosclerosis 197 (2008) 147–153 The metabolic syndrome predicts cardiovascular events in subjects with normal fasting glucose: Results of a 15 years follow-up in a Mediterranean population Davide Noto a,1 , Carlo Maria Barbagallo a,∗,1 , Angelo Baldassare Cefal` u a , Angelo Falletta a , Michelangelo Sapienza b , Giovanni Cavera b , Salvatore Amato a , Michele Pagano c , Maria Maggiore a , Antonio Carroccio a , Alberto Notarbartolo a , Maurizio R. Averna a,∗∗ a Department of Clinical Medicine and Emerging Diseases, University of Palermo, Palermo, Italy b Department of Geriatrics, “Villa Sofia” Hospital, Palermo, Italy c Department of Geriatrics, “A.U.S.L. 6”, Palermo, Italy Received 30 May 2006; received in revised form 7 March 2007; accepted 7 March 2007 Available online 26 April 2007 Abstract The aim of this study was to evaluate the cardiovascular (CV) risk due to the metabolic syndrome in a 15-year prospective study of a Sicilian population. In the Mediterranean area obesity is highly prevalent, but epidemiological data on the metabolic syndrome are limited. Methods and results: Among the 1351 subjects enrolled in the “Ventimiglia di Sicilia” epidemiological project, we selected 687 subjects between 35 and 75 years of age; baseline parameters were assessed and subjects have been followed for 15 years recording CV events, total and cardiovascular mortality. The metabolic syndrome was defined according to both the Adult Treatment Panel III and the International Diabetes Federation criteria. Metabolic syndrome (ATPIII criteria) was significantly (p < 0.00001) more prevalent in women (31.5%) than in men (12.4%). The metabolic syndrome increased the risk of CV events with a hazard ratio of 1.9 (confidence interval CI; 1.46–2.46). Using a Cox proportional hazards estimation model, the survival curve of subjects with metabolic syndrome and normal fasting glucose did not significantly differ from the curve of subjects with metabolic syndrome and impaired fasting glucose (IFG). Conclusions: In a 15-year follow-up the metabolic syndrome is predictive of CV events regardless of the presence of IFG or diabetes mellitus. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Epidemiology; Cardiovascular disease; Metabolic syndrome 1. Introduction The term “metabolic syndrome” identifies a cluster of risk factors associated to the cardiovascular disease (CVD) ∗ Corresponding author at: Department of Clinical Medicine and Emerging Disease, Via del Vespro 141, I-90127 Palermo, Italy. Tel.: +39 091 6552891; fax: +39 091 6552936. ∗∗ Corresponding author at: Department of Clinical Medicine and Emerging Disease, Via del Vespro 141, I-90127 Palermo, Italy. Tel.: +39 091 6552993; fax: +39 091 6552936. E-mail addresses: carlob@unipa.it (C.M. Barbagallo), avernam@unipa.it (M.R. Averna). 1 These authors equally contributed to the work. [1]. The same risk factors have been clustered under dif- ferent definitions, such as syndrome X, insulin resistance syndrome or polymetabolic syndrome [2–4]. A recent defini- tion of metabolic syndrome has been published as part of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) recommendations [5]. According to this definition, patients with metabolic syndrome cluster at least 3 of the 5 following risk factors: high blood glucose, hypertension, high plasma triglycerides, low plasma HDL- cholesterol and abdominal obesity expressed by an increased waist circumference. Recently, some concerns about the definition of the metabolic syndrome and its underlying pathophysiological basis have been raised [6,7], therefore 0021-9150/$ – see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.atherosclerosis.2007.03.005