Systematic Review of the Epidemiology and Natural History of the Metabolic Vascular Syndrome and its Coincidence with Type 2 Diabetes Mellitus and Cardiovascular Diseases in Different European Countries

Caroline Kwasny; Ulf Manuwald; Joachim Kugler; Ulrike Rothe

doi:10.1055/s-0043-122395

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2018; 50(03): 201-208
DOI: 10.1055/s-0043-122395

Review

Systematic Review of the Epidemiology and Natural History of the Metabolic Vascular Syndrome and its Coincidence with Type 2 Diabetes Mellitus and Cardiovascular Diseases in Different European Countries

Caroline Kwasny

¹Health Sciences/Public Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

,

Ulf Manuwald

¹Health Sciences/Public Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

,

Joachim Kugler

¹Health Sciences/Public Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

,

Ulrike Rothe

¹Health Sciences/Public Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

› Author Affiliations

Abstract

The objectives of this systematic review were to estimate the incidence, prevalence and natural history of the metabolic (vascular) syndrome (MVS) among adults in different European countries. Furthermore, we assessed its co-incidence with type 2 diabetes (T2DM) and cardiovascular diseases (CVD). PubMed, MedLine, and EMBASE (via Ovid) were searched for relevant studies. After reading 116 full-text articles to find eligible ones, 66 publications met our inclusion criteria. Data for the incidence are based on a study from Portugal, in which the incidence rate for the MVS was 47.2/1000 person-years. Prevalence varied strongly depending on country and definition. The lowest was found in the United Kingdom (3%), the highest in Finland (71.7%). No article that deals with the natural history of the MVS was found. Considering the co-existence of MVS and T2DM, it ranged between 2% (United Kingdom) and 74.4% (Spain). The co-occurrence of MVS and CVD ranged from 2.8% (Italy) up to 52% (Netherlands). Coronary heart disease (CHD) varied between 1.2% and 44.2%. With regard to peripheral artery disease (PAD), values between 3.3% and 59.8% were found. Due to the many different definitions of the MVS, a comparison is very difficult. Overall prevalence ranged between 3% and 71.7% depending on definition, age, and country. An association between MVS and T2DM as well as several CVD can be assumed.

Key words

metabolic syndrome - incidence - prevalence - clinical course - prediabetes

Full Text

References

References
1 Hanefeld M, Leonhardt W. Das metabolische Syndrom. Dt Gesundh Wesen 1981; 36: 545-551
2 Koch CA, Bornstein SR, Birkenfeld AL. Introduction to Hanefeld Symposium: 40+ years of metabolic syndrome. Rev Endocr Metab Disord 2017; 17: 1-4
3 Reaven GM. Banting lecture. Role of insulin resistance in human disease. Diabetes 1988; 37: 595-607
4 Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WPT, Loria CM, Smith Jr. SC. International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the Metabolic Syndrome. A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640-1645
5 Alberti KG, Zimmet PZ, Shaw J. Metabolic syndrome–a new world-wide definition. A consensus statement from the international diabetes federation. Diabet Med 2006; 23: 469-480
6 Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 1999; 16: 442-443
7 Grundy MD, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith Jr. SC, Spertus JA, Costa F. American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and Management of the Metabolic Syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112: 2735-2752
8 Grundy MD, Becker D, Luther T, Clark MD, Cooper RS, Denke MA, James HW, Donald B, Hunninghake D, Illingworth R, Luepker RV, McBride P, McKenney JM, Pasternak RC, Stone NJ, Van Horn L. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 2002; 106: 47
9 WHO. Definition, diagnosis and classification of diabetes mellitus and its complications. Diabet Med 1999; 15: 539-553
10 Fachkommission Diabetes der SLÄK und KV Sachsen in Zusammenarbeit mit einem unabhängigen wissenschaftlichen Beirat von Experten verschiedener Fachdisziplinen. Praxis-Leitlinie Metabolisch-Vaskuläres Syndrom 2017 (Publication planned for 2017). 3. Auflage Dresden:
11 Santos AC, Severo M, Barros H. Incidence and risk factors for the metabolic syndrome in an urban South European population. Prev Med 2010; 50: 99-105
12 Agyemang C, van Valkengoed IG, van den Born BJ, Bhopal R, Stronks K. Heterogeneity in sex differences in the metabolic syndrome in Dutch white, Surinamese African and South Asian populations. Diabet Med 2012; 29: 1159-1164
13 Alkerwi A, Donneau AF, Sauvageot N, Lair ML, Scheen A, Albert A, Guillaume M. Prevalence of the metabolic syndrome in Luxembourg according to the Joint Interim Statement definition estimated from the ORISCAV-LUX study. BMC Public Health 2011; 11: 4
14 Athyros VG, Ganotakis ES, Tziomalos K, Papageorgiou AA, Anagnostis P, Griva T, Kargiotis K, Mitsiou EK, Karagiannis A, Mikhailidis DP. Comparison of four definitions of the metabolic syndrome in a Greek (Mediterranean) population. Curr Med Res Opin 2010; 26: 713-719
15 Azimi-Nezhad M, Herbeth B, Siest G, Dade S, Ndiaye NC, Esmaily H, Hosseini SJ, Ghayour-Mobarhan M, Visvikis-Siest S. High prevalence of metabolic syndrome in Iran in comparison with France: what are the components that explain this?. Metab Syndr Relat Disord 2012; 10: 181-188
16 Bellia A, Giardina E, Lauro D, Tesauro M, Di Fede G, Cusumano G, Federici M, Rini GB, Novelli G, Lauro R, Sbraccia P. "The Linosa Study": epidemiological and heritability data of the metabolic syndrome in a Caucasian genetic isolate. Nutr Metab Cardiovasc Dis 2009; 19: 455-461
17 Broderstad AR, Melhus M. Prevalence of metabolic syndrome and diabetes mellitus in Sami and Norwegian populations. The SAMINOR-a cross-sectional study. BMJ Open 2016; 6: 1-7
18 Buckland GG, Salas-Salvado J, Serra-Majem L, Castell C, Cabre J, Salleras-Sanmarti L. Increase in metabolic syndrome as defined by ATPIII from 1992-1993 to 2002-2003 in a Mediterranean population. Nutr Rev 2009; 67 (Suppl. 01) 117-125
19 Corrado E, Rizzo M, Caccamo G, Coppola G, Muratori I, Tantillo R, Dell'oglio S, Nugara C, Macaione F, Novo G, Alcamo R, Mignano A, Ferrara F, Novo S. Prevalence of metabolic syndrome: A comparative analysis in an unselected sample of mediterranean subjects. Int Angiol 2012; 1: 572-578
20 Cortez-Dias N, Martins S, Belo A, Fiuza M. Comparison of definitions of metabolic syndrome in relation to risk for coronary artery disease and stroke. Rev Port Cardiol 2011; 30: 139-169
21 Creavin ST, Gallacher J, Bayer A, Fish M, Ebrahim S, Ben-Shlomo Y. Metabolic syndrome, diabetes, poor cognition, and dementia in the Caerphilly prospective study. J Alzheimers Dis 2012; 28: 931-939
22 De Luis DA, Lopez Mongil R, Gonzalez Sagrado M, Lopez Trigo JA, Mora PF, Castrodeza Sanz J. Prevalence of metabolic syndrome with International Diabetes Federation Criteria and ATP III Program in patients 65 years of age or older. J Nutr Health Aging 2010; 14: 400-404
23 Deka R, Durakovic Z, Niu W, Zhang G, Karns R, Smolej-Narancic N, Missoni S, Caric D, Caric D, Rudan D, Salzer B, Chakraborty R, Rudan P. Prevalence of metabolic syndrome and related metabolic traits in an island population of the Adriatic. Ann Hum Biol 2012; 39: 46-53
24 Fernandez-Berges D, Cabrera de Leon A, Sanz H, Elosua R, Guembe MJ, Alzamora M, Vega-Alonso T, Felix-Redondo FJ, Ortiz-Marron H, Rigo F, Lama C, Gavrila D, Segura-Fragoso A, Lozano L, Marrugat J. Metabolic syndrome in Spain: prevalence and coronary risk associated with harmonized definition and WHO proposal. DARIOS study. Rev Esp Cardiol (Engl Ed) 2012; 65: 241-248
25 Gavrila D, Salmeron D, Egea-Caparros JM, Huerta JM, Perez-Martinez A, Navarro C, Tormo MJ. Prevalence of metabolic syndrome in Murcia Region, a southern European Mediterranean area with low cardiovascular risk and high obesity. BMC Public Health 2011; 11: 562-571
26 Guallar-Castillon P, Perez RF, Lopez Garcia E, Leon-Munoz LM, Aguilera MT, Graciani A, Gutierrez-Fisac JL, Banegas JR, Rodriguez-Artalejo F. Magnitude and management of metabolic syndrome in Spain in 2008-2010: the ENRICA study. Rev Esp Cardiol (Engl Ed) 2014; 67: 367-373
27 Gundogan K, Bayram F, Capak M, Tanriverdi F, Karaman A, Ozturk A, Altunbas H, Gokce C, Kalkan A, Yazici C. Prevalence of metabolic syndrome in the Mediterranean region of Turkey: evaluation of hypertension, diabetes mellitus, obesity, and dyslipidemia. Metab Syndr Relat Disord 2009; 7: 427-734
28 Ilow R, Regulska-Ilow B, Rozanska D, Kowalisko A, Biernat J. Prevalence of metabolic syndrome among 40- and 50-year-old inhabitants of Wroclaw, Poland. Ann Agric Environ Med 2012; 19: 551-556
29 Ivezic-Lalic D, Bergman Markovic B, Kranjcevic K, Kern J, Vrdoljak D, Vucak J. Diversity of metabolic syndrome criteria in association with cardiovascular diseases–a family medicine-based investigation. Med Sci Monit 2013; 19: 571-578
30 Kabalin M, Sarac J, Saric T, Kapovic M. Metabolic syndrome among the inhabitants of the Island of Cres. Coll Antropol 2012; 36: 745-754
31 Kosa Z, Moravcsik-Kornyicki A, Dioszegi J, Roberts B, Szabo Z, Sandor J, Adany R. Prevalence of metabolic syndrome among Roma: a comparative health examination survey in Hungary. Eur J Public Health 2015; 25: 299-304
32 Koziarska-Rosciszewska M, Panasiuk M, Cypryk K. Prevalence of metabolic syndrome and its' components in the young adult-students of universities in Lodz, Poland. Pediatr Endocrinol Diabetes Metab 2010; 16: 277-283
33 Luksiene DI, Baceviciene M, Tamosiunas A, Cerniauskiene LR, Margeviciene L, Reklaitiene R. Prevalence of the metabolic syndrome diagnosed using three different definitions and risk of ischemic heart disease among Kaunas adult population. Medicina (Kaunas) 2010; 46: 61-69
34 Luksiene DI, Baceviciene M, Tamosiunas A, Reklaitiene R, Radisauskas R. Comparison of four definitions of the metabolic syndrome and odds of ischemic heart disease in the Lithuanian urban population. Int J Public Health 2012; 57: 543-550
35 Martinez-Larrad MT, Corbaton-Anchuelo A, Fernandez-Perez C, Lazcano-Redondo Y, Escobar-Jimenez F, Serrano-Rios M. Metabolic syndrome, glucose tolerance categories and the cardiovascular risk in Spanish population. Diabetes Res Clin Pract 2016; 114: 23-31
36 Metelskaya VA, Shkolnikova MA, Shalnova SA, Andreev EM, Deev AD, Jdanov DA, Shkolnikov VM, Vaupel JW. Prevalence, components, and correlates of metabolic syndrome (MS) among elderly Muscovites. Arch Gerontol Geriatr 2012; 55: 231-237
37 Miettola J, Nykanen I, Kumpusalo E. Health views and metabolic syndrome in a Finnish rural community: a cross-sectional population study. Can J Rural Med 2012; 17: 10-16
38 Moebus S, Balijepalli C, Losch C, Gores L, von Stritzky B, Bramlage P, Wasem J, Jockel KH. Age- and sex-specific prevalence and ten-year risk for cardiovascular disease of all 16 risk factor combinations of the metabolic syndrome – A cross-sectional study. Cardiovasc Diabetol 2010; 9: 34
39 Motta M, Bennati E, Cardillo E, Passamonte M, Ferlito L, Malaguarnera M. The metabolic syndrome (MS) in the elderly: Considerations on the diagnostic criteria of the International Diabetes Federation (IDF) and some proposed modifications. Arch Gerontol Geriatr 2009; 48: 380-384
40 Noale M, Maggi S, Zanoni S, Limongi F, Zambon S, Crepaldi G. The metabolic syndrome, incidence of diabetes and mortality among the elderly: the Italian Longitudinal Study of Ageing. Diabetes Metab 2012; 38: 135-141
41 Novak M, Bjorck L, Welin L, Welin C, Manhem K, Rosengren A. Gender differences in the prevalence of metabolic syndrome in 50-year-old Swedish men and women with hypertension born in 1953. J Hum Hypertens 2013; 27: 56-61
42 Novelletto BF, Guzzinati S, Avogaro A. Prevalence of metabolic syndrome and its relationship with clinically prevalent cardiovascular disease in the Veneto region, northeastern Italy. Metab Syndr Relat Disord 2012; 10: 56-62
43 Novo S, Peritore A, Guarneri FP, Corrado E, Macaione F, Evola S, Novo G. Metabolic syndrome (MS) predicts cardio and cerebrovascular events in a twenty years follow-up. A prospective study. Atherosclerosis 2012; 223: 468-472
44 Orgaz Gallego MP, Bermejo Lopez P, Tricio Armero MA, Abellan Aleman J, Solera Albero J, Tarraga Lopez PJ. Metabolic syndrome and its components in Spanish postmenopausal women. Nutr Hosp 2015; 32: 656-666
45 Pajunen P, Rissanen H, Harkanen T, Jula A, Reunanen A, Salomaa V. The metabolic syndrome as a predictor of incident diabetes and cardiovascular events in the Health 2000 Study. Diabetes Metab 2010; 36: 395-401
46 Pasalic D, Dodig S, Corovic N, Pizent A, Jurasovic J, Pavlovic M. High prevalence of metabolic syndrome in an elderly Croatian population - a multicentre study. Public Health Nutr 2011; 14: 1650-1657
47 Rothe U, Muller G, Tselmin S, Odenbach C, Scheuch K, Koch R, Bergmann S, Walter M, Bergmann A, Bornstein SR, Schwarz PE. Prevalence for the cluster of risk factors of the Metabolic Vascular Syndrome in a working population in Germany. Horm Metab Res 2009; 41: 168-170
48 Scott J, Gavin J, Egan AM, Avalos G, Dennedy MC, Bell M, Dunne F. The prevalence of diabetes, pre-diabetes and the metabolic syndrome in an Irish regional homeless population. QJM 2013; 106: 547-553
49 Sidorenkov O, Nilssen O, Brenn T, Martiushov S, Arkhipovsky VL, Grjibovski AM. Prevalence of the metabolic syndrome and its components in Northwest Russia: the Arkhangelsk study. BMC Public Health 2010; 10: 23-32
50 Suliga E, Koziel D, Gluszek S. Prevalence of metabolic syndrome in normal weight individuals. Ann Agric Environ Med 2016; 23: 631-635
51 Szigethy E, Szeles G, Horvath A, Hidvegi T, Jermendy G, Paragh G, Blasko G, Adany R, Voko Z. Epidemiology of the metabolic syndrome in Hungary. Public Health 2012; 126: 143-149
52 Szostak-Wegierek D, Waskiewicz A. Metabolic disorders in women at procreative age living in Warsaw. Rocz Panstw Zakl Hig 2015; 66: 245-251
53 Tauler P, Bennasar-Veny M, Morales-Asencio JM, Lopez-Gonzalez AA, Vicente-Herrero T, De Pedro-Gomez J, Royo V, Pericas-Beltran J, Aguilo A. Prevalence of premorbid metabolic syndrome in Spanish adult workers using IDF and ATPIII diagnostic criteria: Relationship with cardiovascular risk factors. PLoS One 2014; 9: e89281
54 Tome MA, Botana MA, Cadarso-Suarez C, Rego-Iraeta A, Fernandez-Marino A, Mato JA, Solache I, Perez-Fernandez R. Prevalence of metabolic syndrome in Galicia (NW Spain) on four alternative definitions and association with insulin resistance. J Endocrinol Invest 2009; 32: 505-511
55 Tyrovolas S, Chalkias C, Morena M, Tsiligianni I, Zeimbekis A, Gotsis E, Metallinos G, Bountziouka V, Polychronopoulos E, Lionis C, Panagiotakos D. Health care access and prevalence of the metabolic syndrome among elders living in high-altitude areas of the Mediterranean islands: the MEDIS study. Rev Diabet Stud 2011; 8: 468-476
56 Waterhouse DF, McLaughlin AM, Sheehan F, O'Shea D. An examination of the prevalence of IDF- and ATPIII-defined metabolic syndrome in an Irish screening population. Ir J Med Sci 2009; 178: 161-166
57 Carlsson AC, Wandell PE, Halldin M, De Faire U, Hellenius ML. Is a unified definition of metabolic syndrome needed? Comparison of three definitions of metabolic syndrome in 60-year-old men and women. Metab Syndr Relat Disord 2009; 7: 231-242
58 Janszky I, Vatten L, Romundstad P, Laugsand LE, Bjorngard JH, Manczuk M, Zatonski WA. Metabolic syndrome in Poland - the PONS study. Ann Agric Environ Med 2011; 18: 270-272
59 Saukkonen T, Jokelainen J, Timonen M, Cederberg H, Laakso M, Harkonen P, Keinanen-Kiukaanniemi S, Rajala U. Prevalence of metabolic syndrome components among the elderly using three different definitions: a cohort study in Finland. Scand J Primary Health Care 2012; 30: 29-34
60 van Vliet-Ostaptchouk JV, Nuotio ML, Slagter SN, Doiron D, Fischer K, Foco L, Gaye A, Gogele M, Heier M, Hiekkalinna T, Joensuu A, Newby C, Pang C, Partinen E, Reischl E, Schwienbacher C, Tammesoo ML, Swertz MA, Burton P, Ferretti V, Fortier I, Giepmans L, Harris JR, Hillege HL, Holmen J, Jula A, Kootstra-Ros JE, Kvaløy K, Holmen TL, Männistö S, Metspalu A, Midthjell K, Murtagh MJ, Peters A, Pramstaller PP, Saaristo T, Salomaa V, Stolk RP, Uusitupa M, van der Harst P, van der Klauw MM, Waldenberger M, Perola M, Wolffenbuttel BH. The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies. BMC Endocr Disord 2014; 14: 9
61 Eglit T, Rajasalu T, Lember M. Metabolic syndrome in estonia: prevalence and associations with insulin resistance. Int J Endocrinol 2012; 951672
62 Bianchi C, Miccoli R, Bonadonna RC, Giorgino F, Frontoni S, Faloia E, Marchesini G, Dolci MA, Alviggi L, Gnasso A, Consoli A, Cavalot F, Cavallo MG, Leonetti F, Giaccari A, Del Prato S. GENFIEV Investigators. Metabolic syndrome in subjects at high risk for type 2 diabetes: the genetic, physiopathology and evolution of type 2 diabetes (GENFIEV) study. Nutr Metab Cardiovasc Dis 2011; 21: 699-705
63 Bruno G, Fornengo P, Segre O, Novelli G, Panero F, Perotto M, Zucco C, Bargero G, Cavallo-Perin P. What is the clinical usefulness of the metabolic syndrome? The Casale Monferrato study. J Hypertens 2009; 27: 2403-2408
64 Salminen M, Kuoppamaki M, Vahlberg T, Raiha I, Irjala K, Kivela SL. Metabolic syndrome defined by modified International Diabetes Federation criteria and type 2 diabetes mellitus risk: a 9-year follow-up among the aged in Finland. Diab Vasc Dis Res 2013; 10: 11-16
65 Khunti K, Taub N, Tringham J, Jarvis J, Farooqi A, Skinner TC, Davies MJ. Screening for the metabolic syndrome using simple anthropometric measurements in South Asian and white Europeans: A population-based screening study. The Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) Study. Primary Care Diabetes 2010; 4: 25-32
66 Broekhuizen LM, Boekholdt SM, Arsenault BJ, Despres JP, Stroes ES, Kastelein JJ, Khaw KT, Wareham NJ. Physical activity, metabolic syndrome, and coronary risk: the EPIC-Norfolk prospective population study. Eur J Cardiovasc Prev Rehabil 2011; 18: 209-217
67 Giampaoli S, Stamler J, Donfrancesco C, Panico S, Vanuzzo D, Cesana G, Mancia G, Pilotto L, Mattiello A, Chiodini P, Palmieri L. Progetto CUORE Research Group. The metabolic syndrome: A critical appraisal based on the CUORE epidemiologic study. Prev Med 2009; 48: 525-531
68 Kastorini CM, Panagiotakos DB, Georgousopoulou EN, Laskaris A, Skourlis N, Zana A, Chatzinikolaou C, Chrysohoou C, Puddu PE, Tousoulis D, Stefanadis C, Pitsavos C. ATTICA Study Group. Metabolic syndrome and 10-year cardiovascular disease incidence: The ATTICA study. Nutr Metab Cardiovasc Dis 2016; 26: 223-231
69 Laclaustra M, Ordonez B, Leon M, Andres EM, Cordero A, Pascual-Calleja I, Grima A, Luengo E, Alegria E, Pocovi M, Civeira F, Casasnovas-Lenguas JA. Metabolic syndrome and coronary heart disease among Spanish male workers: A case-control study of MESYAS. Nutr Metab Cardiovasc Dis 2012; 22: 510-516
70 Maksimovic M, Vlajinac H, Radak D, Marinkovic J, Jorga J. Relationship between peripheral arterial disease and metabolic syndrome. Angiology 2009; 60: 546-553
71 Qiao Q, Laatikainen T, Zethelius B, Stegmayr B, Eliasson M, Jousilahti P, Tuomilehto J. Comparison of definitions of metabolic syndrome in relation to the risk of developing stroke and coronary heart disease in Finnish and Swedish cohorts. Stroke 2009; 40: 337-343
72 Rachas A, Raffaitin C, Barberger-Gateau P, Helmer C, Ritchie K, Tzourio C, Amouyel P, Ducimetiere P, Empana JP. Clinical usefulness of the metabolic syndrome for the risk of coronary heart disease does not exceed the sum of its individual components in older men and women. The Three-City (3C) Study. Heart 2012; 98: 650-655
73 Reijmer YD, van den Berg E, Dekker JM, Nijpels G, Stehouwer CD, Kappelle LJ, Biessels GJ. The metabolic syndrome, atherosclerosis and cognitive functioning in a non-demented population: The Hoorn Study. Atherosclerosis 2011; 219: 839-845
74 Salminen M, Kuoppamaki M, Vahlberg T, Raiha I, Irjala K, Kivela SL. Metabolic syndrome and vascular risk: A 9-year follow-up among the aged in Finland. Acta Diabetol 2011; 48: 157-165
75 Schmidt C, Bergstrom GM. The metabolic syndrome predicts cardiovascular events: Results of a 13-year follow-up in initially healthy 58-year-old men. Metab Syndr Relat Disord 2012; 10: 394-399
76 Vishram JKK, Borglykke A, Andreasen AK, Jeppesen J, Ibsen H, Jørgensen T, Palmieri L, Giampaoli S, Donfrancesco C, Kee F, Mancia G, Cesana G, Kuulasmaa K, Salomaa V, Sans S, Ferrieres J, Dallongeville J, Söderberg S, Arveiler D, Wagner A, Tunstall-Pedoe H, Drygas W, Olsen MH. on behalf of the MORGAM Project. Impact of age and gender on the prevalence and prognostic importance of the metabolic syndrome and its components in Europeans. The MORGAM Prospective Cohort Project. PLoS One 2014; 9: e107294
77 Woodward M, Tunstall-Pedoe H. The metabolic syndrome is not a sensible tool for predicting the risk of coronary heart disease. Eur J Cardiovasc Prev Rehabil 2009; 16: 210-214
78 Chen G, Shi L, Cai L, Lin W, Huang H, Liang J, Li L, Lin L, Tang K, Chen L, Lu J, Bi Y, Wang W, Ning G, Wen J. Comparison of insulin resistance and b-cell dysfunction between the young and the elderly in normal glucose tolerance and prediabetes population: A prospective study. Horm Metab Res 2017; 49: 135-141

Supplementary Material

Supplementary Material