American Journal of Epidemiology Vol. 153, No. 5 : 481-489
Copyright © 2001 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Metabolic Syndrome and Ischemic Heart Disease in Elderly Men and Women
1 Department of Community Medicine, Malmö University Hospital, Malmö, Sweden.
2 Department of Family and Preventive Medicine, Division of Epidemiology, University of California, San Diego, La Jolla, CA.
Associations between metabolic syndrome components and prevalent ischemic heart disease (IHD) were investigated in a cross-sectional, community-based study of elderly men (n = 1,015) and women (n = 1,259) in Rancho Bernardo, California, in 1984–1987. In both sexes, there were significant positive associations between IHD defined by resting electrocardiogram criteria and age, systolic blood pressure, fasting and postchallenge hyperglycemia, total cholesterol/high density lipoprotein cholesterol (HDL cholesterol) ratio, and triglycerides and an inverse significant association with HDL cholesterol. High collinearity and interactions between serum insulin and metabolic syndrome variables were accounted for by uncorrelated principal components identified by factor analysis. In both men and women, three uncorrelated principal components were identified, representing a central metabolic factor (body mass index, fasting and 2-hour serum insulin, high serum triglycerides, and low HDL cholesterol), a glucose factor, and a blood pressure factor. In a multivariate model with age and sex, all three factors were significantly associated with IHD by electrocardiogram criteria; central metabolic factor (odds ratio (OR) = 1.6, p = 0.001), glucose factor (OR = 1.4, p < 0.001), blood pressure factor (OR = 1.2, p = 0.005), age (10 years) (OR = 1.8, p < 0.001), and female sex (OR = 0.5, p < 0.02). Similar results were obtained in analyses using clinically manifest IHD as the outcome. These results support the thesis that the metabolic syndrome exerts effects through different risk factors by different mechanisms.
blood pressure; body constitution; electrocardiography; glucose; insulin; lipoproteins
Abbreviations: CI, confidence interval; ECG, electrocardiogram; HDL cholesterol, high density lipoprotein cholesterol; IHD, ischemic heart disease; IHD/clinical, clinical ischemic heart disease; IHD/ECG, ischemic heart disease by electrocardiogram; LDL cholesterol, low density lipoprotein cholesterol; OR, odds ratio.
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