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Int J Cardiol. 2013 Sep 20;168(1):369-74. doi: 10.1016/j.ijcard.2012.09.037. Epub 2012 Oct 2.

Prognostic impact of different definitions of metabolic syndrome in predicting cardiovascular events in a cohort of non-diabetic Tehranian adults.

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Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.



The applicability of different definitions of metabolic syndrome (MetS) in predicting cardiovascular diseases (CVD) remains questionable. The aim of this study was to compare predictive ability of different definitions of MetS for CVD in non-diabetic subjects.


In this community-based study, 5198 non-diabetic subjects aged ≥ 30 years (mean age 45.6 years, 45% men) free of CVD at baseline were followed for a median of 9.3 years to assess risk for CVD. We assessed the predictability of definitions of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), the International Diabetes Federation (IDF), the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI), and the joint interim statement (JIS) on development of CVD. Hazard ratios (HRs) were calculated using Cox proportional-hazards models. The receiver operating characteristic (ROC) curve was also used to compare discriminative power of these MetS definitions in predicting CVD events.


Compared to other definitions, the JIS identified more participants (41.8%) having MetS. First CVD events occurred in 311 subjects. After adjustment for potential confounders, the HRs of the NCEP-ATP III, AHA/NHLBI, IDF and JIS definitions for incident CVD were 1.55 (1.21-2.00), 1.73 (1.35-2.20), 1.54 (1.22-1.94) and 1.70 (1.34-2.17), respectively. All definitions showed higher HRs for females in comparison to males (P<0.05). ROC analysis showed no significant difference in the discriminative power of different MetS definitions in predicting CVD events (P>0.05).


In the current study, compared to each other none of the definitions showed a superior discriminative power in predicting CVD; although, all definitions were more predictive in females than in males.


Cardiovascular diseases; Diagnostic criteria; Metabolic syndrome

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