Abstract
About 25% of U.S. adults have the metabolic syndrome (1), a cluster of central obesity; abnormal glucose, insulin, and lipids; and hypertension. Clinicians and the media have increasingly emphasized its diagnosis and treatment (2,3). Several recent prospective studies associate increased cardiovascular disease (CVD) or total mortality risk with the metabolic syndrome in men and younger adults (4–10). Over 90% of CVD mortality in women occurs after 65 years of age (11), and women with diabetes lose sex-protective effects; their CVD relative risk is even greater than men with diabetes (12). Whether the metabolic syndrome increases mortality risk in addition to diabetes is unclear. We prospectively evaluated the syndrome’s association with CVD mortality in older women and whether its risk is greater than diabetes alone. From 1986 to 1988, the Study of Osteoporotic Fractures (SOF) recruited 9,704 community-dwelling women, ≥65 years of age (>99% Non-Hispanic White) in four U.S. regions: Baltimore County, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley near Pittsburgh, Pennsylvania (13). Women unable to walk without assistance and those with bilateral hip replacements were excluded. All participants provided written consent, and SOF was approved by each site’s institutional review board. Waist and hip circumference were measured by standardized protocol (14) to the nearest 0.10 cm with steel tape. Weight was measured by balance beam, height by stadiometer. Blood pressure was measured supine and after standing 1 min; the average …
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