The Metabolic Syndrome and Incident End Stage Peripheral Vascular Disease: A 14-year Follow-up Study in Elderly Finns

OBJECTIVE − We investigated the relationship of the metabolic syndrome (MetS) and its single components, defined by four different criteria, with peripheral vascular disease (PVD) in a prospective population-based study. RESEARCH DESIGN AND METHODS − The MetS was defined according to the World Health Organization (WHO), the National Cholesterol Education Program (NCEP), the International Diabetes Federation (IDF) and the American Heart Association (updated NCEP) criteria. We investigated the relationship of the MetS defined by aforementioned four criteria with PVD (revacularization, amputation) with Cox regression analyses in a Finnish population of 1212 subjects with and without diabetes, aged 65 to 74 years during the 14-year follow-up. RESULTS − The MetS defined by the WHO, NCEP and updated NCEP criteria was associated with a statistically significant risk for incident PVD (n=57) when adjusted for all confounding variables except for prevalent diabetes (hazards ratios, HRs from 1.91 to 2.62). After the adjustment for prevalent diabetes or after the exclusion of subjects with prevalent diabetes, there was no association between the MetS by any criteria and incident PVD. Of the single components of the MetS, elevated fasting glucose by the WHO and NCEP criteria (HR 2.35) and microalbuminuria by the WHO definition (HR 2.56) predicted PVD in multivariable models (prevalent diabetes included). CONCLUSIONS− The MetS defined by the WHO, NCEP and updated NCEP criteria predicted incident end stage PVD in the elderly, but only when not adjusted for diabetes status. Two of the single components of the MetS, elevated FPG and microalbuminuria predicted PVD. We conclude that the MetS predicts PVD, but not above and beyond the risk associated with diabetes and microalbuminuria. Abbreviations ACE American College of Endocrinology ACR the ratio of urinary albumin to urinary creatinine BMI body mass index CHD coronary heart disease CVD cardiovascular disease DBP diastolic blood pressure EGIR European Group for the Study of Insulin Resistance FPG fasting plasma glucose HDL high-density lipoprotein HR hazard ratio IFG impaired fasting glucose IDF International Diabetes Federation IGT impaired glucose tolerance MetS metabolic syndrome MI myocardial infarction NCEP National Cholesterol Education Program OGTT oral glucose tolerance test 2-hPG 2-h post glucose load PVD peripheral vascular disease SBP systolic blood pressure WHO World Health Organization. WHR waist-to-hip ratio