Clinical significance of the metabolic syndrome in the absence of established hypertension and diabetes: A community-based study

Aims/hypothesis: Our aim was to determine the predictive values on the all-cause and cardiovascular mortality and the future risks of hypertension and diabetes of the metabolic syndrome defined by the third report of the National Cholesterol Education Program's Adult Treatment Panel in the absence of established hypertension and diabetes (who may still have elevated blood pressure within 130-139/85-89 mmHg and/or elevated fasting blood glucose within 5.5-6.9 mmol/L (100-125 mg/dL)). Methods: A community-based population of 11,058 Chinese aged 30 years and above in Kinmen island was followed up for 10.6 years. All-cause and cardiovascular mortality and incidence of hypertension and diabetes mellitus were determined. Results: The hazard ratios and 95% confidence intervals for all-cause and cardiovascular mortality in subjects with metabolic syndrome but without hypertension and diabetes versus subjects without metabolic syndrome, hypertension, and diabetes, were 0.81 (0.51-1.30) and 0.89 (0.57-1.37) in men, and 1.14 (0.45-2.92) and 0.73 (0.27-2.68) in women, respectively. In the non-diabetic non-hypertensives at baseline, the odds ratios and 95% confidence intervals for predicting hypertension and diabetes for subjects with versus without the metabolic syndrome were 2.25 (1.80-2.82) and 3.12 (2.30-4.24), respectively. Conclusions/interpretation: In this Chinese population, metabolic syndrome in the absence of hypertension and diabetes was not associated with increased risk of all-cause or cardiovascular mortality. In contrast, the presence of metabolic syndrome predicted future risk of hypertension and diabetes. Therefore, the intervention strategies for subjects with metabolic syndrome may be focused on the prevention of hypertension and diabetes.