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Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality: prospective, population based cohort study

BMJ 2006; 332 doi: (Published 13 April 2006) Cite this as: BMJ 2006;332:878
  1. Johan Sundström, associate professor of cardiovascular epidemiology (johan.sundstrom{at},
  2. Ulf Risérus, postdoctoral research fellow2,
  3. Liisa Byberg, postdoctoral research fellow2,
  4. Björn Zethelius, postdoctoral research fellow2,
  5. Hans Lithell, professor of geriatrics2,
  6. Lars Lind, professor of cardiovascular medicine1
  1. 1 Department of Medical Sciences, Uppsala University Hospital; SE-751 85 Uppsala, Sweden
  2. 2 Department of Public Health and Caring Sciences, Uppsala University Hospital
  1. Correspondence to: J Sundström
  • Accepted 2 February 2006


Objectives To find out if the presence of the metabolic syndrome increases the risk of subsequent total and cardiovascular mortality, taking into account established risk factors for cardiovascular disease.

Design Prospective cohort study.

Setting General population.

Participants A community based sample of 2322 men followed since 1970 for a maximum of 32.7 years, investigated at ages 50 and 70.

Main outcome measures The relations of the metabolic syndrome defined by the national cholesterol education programme (NCEP) of the US National Heart, Lung, and Blood Institute or criteria of the World Health Organization (WHO) to subsequent total and cardiovascular mortality.

Results When adding the metabolic syndrome to models with established risk factors for cardiovascular disease (smoking, diabetes, hypertension, and serum cholesterol) at age 50, presence of the metabolic syndrome as defined in the NCEP significantly predicted total and cardiovascular mortality (Cox proportional hazard ratios 1.36, 95% confidence interval 1.17 to 1.58; and 1.59, 1.29 to 1.95, respectively). The metabolic syndrome added prognostic information to that of the established risk factors for cardiovascular disease (likelihood ratio tests, P < 0.0001 for both outcomes). Similar results were obtained in a subsample without diabetes or manifest cardiovascular disease.

Conclusions In a large, community based sample of middle aged men, the presence of the metabolic syndrome according to the definition of the NCEP gave long term prognostic information regarding total and cardiovascular mortality if the status of established risk factors for cardiovascular disease was known. If confirmed this may indicate clinical value in diagnosing the metabolic syndrome.


  • Embedded ImageCriteria for metabolic syndrome fulfilled at ages 50 and 70 in the total sample are on

    Hans Lithell died on Nov 27, 2005.

  • Contributors JS, UR, LB conceived and designed the study. JS performed planning and analysis. JS drafted the paper. JS, UR, LB, BZ, HL, and LL interpreted the data and revised the paper. JS is guarantor.

  • Funding Thuréus Foundation, the Swedish Heart-Lung Foundation, and the Swedish Society for Medical Research. The funding sources had no involvement in the research.

  • Competing interests None declared.

  • Ethical approval Uppsala University Ethics Committee.

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