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Does the constellation of risk factors with and without abdominal adiposity associate with different cardiovascular mortality risk?

International Journal of Obesity volume 32, pages 757–762 (2008)Cite this article

Abstract

Aims:

To evaluate whether the metabolic syndrome (MetS) defined by the International Diabetes Federation (IDF) criteria, which has abdominal adiposity as a mandatory element, predicts cardiovascular disease (CVD) mortality better than the cluster of other IDF-defined abnormalities not including abdominal adiposity.

Methods:

Data from nine European population-based studies, including 7782 men and 7739 women (aged 30–89 years), with a median follow-up of 8.55 years, were jointly analyzed. Hazard ratios for CVD mortality were calculated with Cox regression models.

Results:

In total, 41% of the men and 38% of the women had the IDF MetS. Individuals with the IDF MetS were by definition more obese and had a higher prevalence of diabetes than non-obese subjects with ⩾2 IDF abnormalities; whereas non-obese men with ⩾3 factors had more atherogenic lipid profiles. Multivariate adjusted hazard ratio for CVD death in men and women with the IDF MetS was 2.44 (1.69–2.98) and 2.32 (1.27–4.23); in non-obese men with 2 and ⩾3 factors the hazard ratio was 1.60 (1.12–2.30) and 2.44 (1.62–3.66), respectively, and in non-obese women with 2 factors the hazard ratio was 2.41 (1.09–5.33).

Conclusions:

The cluster of the CVD risk factors predicted CVD mortality regardless of the presence or absence of the abdominal adiposity. Inclusion of abdominal adiposity as a prerequisite will miss those non-obese individuals who have increased CVD mortality.

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Acknowledgements

This analysis has been carried out with the help of grants from Paulo Foundation, Finland, from Future Forum Research Grant 2004, from Novo Nordisk Foundation 2005 and from Academy Finland (118492). The DECODE Study has been financially supported by unlimited grants from Novo Nordisk, Bagsvaerd, Denmark, from Novartis Pharma AG, Basel, Switzerland, from AstraZeneca R&D Mölndal, Sweden and from Academy of Finland.

Author information

Author notes

  1. Dr W Gao, Department of Public Health, University of Helsinki, Mannerheimintie 172, 6th floor, KTTL, 6krs, PL 41, Helsinki FIN-00014, Finland. E-mail: gao.weiguo@ktl.fi

Authors and Affiliations

    Consortia

    The DECODE Study Group

    Additional information

    Conflict of interest

    The authors state no conflict of interest.

    Appendix

    Appendix

    Organization

    The Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) Study was undertaken in 1997 upon the initiative of the European Diabetes Epidemiology Group.

    Studies and investigators in this collaborative study were

    Finland

    FINMONICA: J Tuomilehto1,2,3, P Jousilahti2 and J Lindström2

    1Department of Public Health, University of Helsinki, Helsinki; 2Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki and 3South Ostrobothnia Central Hospital, Seinäjoki

    FINRISK 2002: J Tuomilehto1,2,3, T Laatikainen2, M Peltonen2 and J Lindström2

    1Department of Public Health, University of Helsinki, Helsinki; 2Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki and 3South Ostrobothnia Central Hospital, Seinäjoki

    Italy

    Cremona Study: MP Garancini, G Calori and G Ruotolo

    Clinical Cardiovascular Biology Research Centre, San Raffaele Scientific Institute, Milan

    The Netherlands

    The Hoorn Study: LM Bouter1, JM Dekker1, RJ Heine1, G Nijpels1 and CDA Stehouwer1,2

    1Vrije Universiteit Medical Center, Institute for Research in Extramural Medicine, Amsterdam and 2Department of Medicine, University Hospital Maastricht, AZ Maastricht

    Poland

    POLMONICA (Krakow): A Pajak and E Kawalec. Unit of Health Care, Department of Epidemiology and Population Studies, Institute of Public Health, Collegium Medicum Jagiellonian University, Krakow

    Sweden

    Northern Sweden MONICA: M Eliasson, B Stegmayr and V Lundberg

    Department of Public Health and Clinical Medicine, University of Umeå, Umeå

    The Uppsala Longitudinal Study of Adult Men (ULSAM): B Zethelius

    Department of Public Health/Geriatrics, Uppsala University Hospital, Uppsala

    UK

    Isle of Ely Diabetes Project: NJ Wareham

    MRC Epidemiology Unit, Strangeways Research Labs, Cambridge

    Newcastle Heart Project: N Unwin, N Ahmad, KGMM Alberti and L Hayes

    Department of Medicine and Epidemiology and Public Health, University of Newcastle, Newcastle

    Secretariat:

    Q Qiao1,2, K Borch-Johnsen3 and J Tuomilehto1,2

    1Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland; 2Department of Public Health, University of Helsinki, Helsinki, Finland and 3Steno Diabetes Center, Gentofte, Denmark

    Data analysis:

    WG Gao1,2 and Q Qiao1,2

    1Department of Public Health, University of Helsinki, Helsinki, Finland and 2Diabetes and Genetic Epidemiology Unit, Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland

    Writing Committee:

    WG Gao1,2, Q Qiao1,2, J Tuomilehto1,2, B Balkau3, G Ruotolo4, G Calor4, MP Garancini4, KMMG Alberti5 and CDA Stehouwer6

    1Department of Public Health, University of Helsinki, Helsinki, Finland; 2Diabetes and Genetic Epidemiology Unit, Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland; 3INSERM U258-IFR69, Paris, France; 4Clinical Cardiovascular Biology Research Centre, San Raffaele Scientific Institute, Milan, Italy; 5Department of Endocrinology and Metabolic Medicine, Mint Wing, St Mary's Hospital, London, UK and 6Department of Medicine, University Hosptial Maastricht, AZ Maastricht, The Netherlands

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    The DECODE Study Group. Does the constellation of risk factors with and without abdominal adiposity associate with different cardiovascular mortality risk?. Int J Obes 32, 757–762 (2008). https://doi.org/10.1038/sj.ijo.0803797

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