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
- Antoine Rachas1,
- Christelle Raffaitin2,
- Pascale Barberger-Gateau2,
- Catherine Helmer2,
- Karen Ritchie3,
- Christophe Tzourio4,
- Philippe Amouyel5,
- Pierre Ducimetière6,
- Jean-Philippe Empana1
- 1Paris Cardiovascular Research Centre, University Paris Descartes, Sorbonne Paris Cité, UMR-S970, Paris, France
- 2INSERM U897, Université Victor Segalen Bordeaux 2, Bordeaux, France
- 3INSERM U1061, Montpellier 1 University, Montpellier, France
- 4INSERM U708, Hôpital de la Pitié-Salpêtrière, Paris, France
- 5INSERM U744, Institut Pasteur de Lille, Lille, France
- 6IFR69, Paris-Sud University, Villejuif, France
- Correspondence to Dr Jean-Philippe Empana, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, Paris 75015, France;
Contributors Conception and design: C. Tzourio, P. Ducimetière Analysis and interpretation of data: A. Rachas, J.P. Empana Drafting the article: A. Rachas, J.P. Empana Critically revising the article for important intellectual content: A. Rachas, C. Raffaitin, P. Barberger-Gateau, C. Helmer, P. Ducimetière, J.P. Empana Final approval of the manuscript: all authors.
- Accepted 31 January 2012
Objectives To investigate the respective associations and clinical usefulness of the metabolic syndrome (MetS) and its individual components to predict the risk of first coronary heart disease (CHD) events in elderly.
Design The Three-City is a French prospective multisite community-based cohort.
Setting Three large French cities: Bordeaux, Dijon and Montpellier.
Participants 7612 subjects aged 65 and over who were free of CHD at baseline.
Main outcome measures The MetS was defined by the 2005 National Cholesterol Education Program Adult Treatment Panel III criteria.
Results During a median follow-up of 5.2 years, 275 first CHD events were adjudicated. The MetS was associated with increased risks of total (adjusted HR: 1.78; 95% CI 1.39 to 2.28), fatal (HR: 2.40; 95% CI 1.41 to 4.09) and non-fatal (HR: 1.64; 95% CI 1.24 to 2.17) CHD events. The association with total CHD was significant in women (HR: 2.56; 95% CI 1.75 to 3.75) but not in men (HR: 1.39; 95% CI 0.99 to 1.94; p for interaction=0.012). When in the same multivariable model, hyperglycemia and abdominal adiposity in women, hyperglycemia, lower HDL cholesterol and abdominal adiposity (inverse association) in men were the components significantly associated with CHD. The components of the MetS but not the MetS itself improved risk prediction beyond traditional risk factors (NRI= 9.35%, p<0;001).
Conclusion The MetS is a risk marker for CHD in community-dwelling elderly subjects but may not be useful for CHD risk prediction purposes compared to its individual components.
- Metabolic syndrome
- coronary heart disease
- risk stratification
Funding The Three-City Study was conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM), the Victor Segalen–Bordeaux II University, and Sanofi-Aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The 3C Study was also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, Institut de la Longévité, Conseils Régionaux of Aquitaine and Bourgogne, Fondation de France, and Ministry of Research–INSERM Programme “Cohortes et collections de données biologiques.” Researchers were independent of funding organisations.
Competing interests None.
Patient consent As mentioned in the manuscript, each participant had signed a french local informed consent.
Ethics approval The ethics approval was provided by Ethical Committee of the University Hospital of Kremlin-Bicêtre.
Provenance and peer review Not commissioned; externally peer reviewed.
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