Wassink AMJ et al. (2008) Metabolic syndrome and the risk of new vascular events and all-cause mortality in patients with coronary artery disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm. Eur Heart J 29: 213–223

Different definitions exist for metabolic syndrome, but it is unknown whether the criteria used to diagnose the syndrome affect a patient's outcome. Wassink et al. investigated this issue with regard to cardiovascular events by conducting a prospective study. They concluded that patients with clinically manifest vascular disease and metabolic syndrome as defined by the National Cholesterol Education Program (NCEP) criteria or the revised NCEP (NCEP-R) criteria might benefit from more-aggressive treatment of cardiovascular risk factors.

In all, 3,196 consecutive patients with either a history or a recent diagnosis of atherosclerotic vascular disease were recruited from the University Medical Centre Utrecht from January 1996 to March 2005. The patients were assessed for the presence of metabolic syndrome according to the NCEP criteria, the NCEP-R criteria, and the International Diabetes Federation (IDF) criteria (n = 1,362 [43%], 1,601 [50%] and 1,375 [43%], respectively). Patients who met the NCEP and NCEP-R criteria had notably increased risks of new vascular events (hazard ratio 1.50, 95% CI 1.22–1.85, after adjustment for age and sex) and mortality (hazard ratio 1.43, 95% CI 1.15–1.78, after adjustment for age and sex). This risk was irrespective of the presence of type 2 diabetes mellitus and the site of clinical manifestation of atherosclerosis. In addition, in patients who were at recommended levels of systolic blood pressure (<140 mmHg) or LDL cholesterol (<2.5 mmol/l) according to current guidelines, presence of NCEP-R-defined metabolic syndrome pointed to increased cardiovascular risk.