Metabolic syndrome and diabetes, alone and in combination as predictors of cardiovascular disease mortality among men

Objective: To examine cardiovascular disease (CVD) mortality risk in men with diabetes only, metabolic syndrome only and concurrent metabolic syndrome and diabetes.

Research design and methods: We examined CVD mortality risk by metabolic syndrome and diabetes status in men from the Aerobics Center Longitudinal Study (mean age [SD]: 45.1 [10.2] years). Participants were categorized as having neither diabetes nor metabolic syndrome (n=23,770), metabolic syndrome only (n=8,780), diabetes only (n=532) or both (n=1,097). The mean duration of follow-up was 14.6 (7.0) years with a total of 483,079 man-years of exposure and 1,085 CVD deaths.

Results: Age, examination year and smoking adjusted CVD death rates (per 1,000 man-years) in men with neither metabolic syndrome nor diabetes, metabolic syndrome only, diabetes only, and both were 1.9, 3.3, 5.5 and 6.5, respectively. CVD mortality was higher in men with metabolic syndrome only (HR [95% CI]: 1.8 [1.5, 2.0]), diabetes only (2.9 [2.1, 4.0]), and both (3.4 [2.8, 4.2]) compared to men with neither. The presence of metabolic syndrome was not associated (1.2 [0.8, 1.7]) with higher CVD mortality risk in individuals with diabetes. In contrast, the presence of diabetes substantially increased (2.1 [1.7, 2.6]) CVD mortality risk in individuals with metabolic syndrome.

Conclusions: The presence of diabetes was associated with a 3-fold higher CVD mortality risk, and metabolic syndrome status did not modify this risk. Our findings support that physicians should be aggressive in utilizing CVD risk reducing therapies in all diabetic patients regardless of metabolic syndrome status.