TABLE 1. Characteristics of 21 Cohort Studies of the Metabolic Syndrome Associated with the Risk of All-cause Mortality

Source / Study Objectives / Country or Region / Name of the Study Cohort / Participants / Sample Size / Age Range of Parti-cipants / Definition and process of MetS / MetS Prevalence at Baseline / Duration of Follow-Up (Year) / Measures of Outcome / Deaths Number / Adjusting Variables
Trevisan 199816 / Analyzed the prevalence of the cluster of metabolic abnormalities defined as syndrome X and its impact on cardiovascular disease mortality / Italy / Risk Factors and Life Expectancy Project / General population (men and women) / 41,056 / 20-69 / Self-definition: high blood glucose, highBP, low high density lipoprotein cholesterol, and high triglycerides / 3.2 / 7 / Investigators and nosologists / 1,218 / Age
Lakka et al, 200223 / Assessed the association of the MetS with cardiovascular and overall mortality / Finland / Kyopio Ischaemic Heart Disease Risk Factor Study / Finnish men / 1,209 / 42-60 / NCEP / 11.0 / 11.4 / National death registry / 109 / Age, examination year, LDL cholesterol, smoking, family history of CHD, fibrinogen, white blood cell, alcohol, and socioeconomic status.
Hunt et al, 200428 / Examined the relation between the MetS and all-cause and cardiovascular disease. / US / San Antonio Heart Study (SAHS) / General population (men and women) / 2,815 / 25-64 / NCEP / 23.2 / 12.7 / Death certificates / 132 / Age, sex and ethnic group
Malik et al, 200436 / Examined the effect of MetS on CHD, CVD and overall mortality / US / Second National Health and Nutrition Examination Survey
(NHANES II) / General population (men and women) / 6,255 / 30-74 / NCEP / 26.0 / 14.0 / Death certificates / 2,145 / Age, sex, smoking, physical activity, and total cholesterol
Dekker et al, 200426 / Presented the agreement of different definitions of the MetS and their predictive value for total mortality and for fatal and nonfatal CVD / Netherlands / Hoorn Study / General population (men and women) / 1,364 / 50-75 / NCEP / 22.7 / 10.0 / Medical records of the general practitioners and the local hospital / 164 / Usual clinical practice, smoking and LDL cholesterol
Katzmarzyk et al, 200524 / Determined the risk of all-cause and CVD mortality associated with the MetS and the influence of cardiorespiratory fitness / US / AerobicsCenter Longitudinal Study (ACLS) / General population (men) / 19,173 / 20-83 / NCEP / 19.5 / 10.2 / Official death certificates / 477 / Age, year of examination, smoking, alcohol, possible existence of CVD, and parental history of premature CVD.
Otiniano 200537 / Examined the effect of MetS on heart attack and overall mortality / US / Hispanic Established Population for the Epidemiological Study of the Elderly / General Mexican Americans (men and women) / 3,050 / 70.3-73.7 / WHO / 11 / 7 / National Death Index and family members / 1,123 / Age, sex, live alone, education, smoking drinking, physical activities diabetes, hypertension and obesity
Ravaglia et al, 200638 / Investigated the prevalence of MetS and its association with all-cause mortality and whether measurements of serum C-reactive protein or interleukin--6 affected this association / Italy / The Conselice Study of Brain Ageing (CSBA) / Elderly men and women / 981 / 65-97 / NCEP / 27.2 / 3.8 / Death certificates / 137 / Age, sex, education, albumin, smoking, physical activity, and preexisting diseases
Sundström 200625 / Investigated if the presence of the MetS increases the risk of subsequent total and cardiovascular mortality / Sweden / General population (men) / 2,322 / 50 / WHO / 12 / 29.8 / National register / 1,078 / Smoking, diabetes, hypertension and total cholesterol
Thomas et al, 200730 / Described the association of the MetS with mortality / Hong Kong / Cardiovascular Risk Factors Prevalence Study / General population (men and women) / 2,863 / 25-74 / NCEP / 17.6 / 8.5 / Hong Kong death registry / 89 / Age, sex, education, job activity, leisure-time activity, smoking and alcohol
Hong et al, 200739 / Investigated the prospective association between MetS and CHD and all-cause mortality / US / Atherosclerosis Risk in Communities Study / Middle-aged men and women / 14,699 / 45-64 / NCEP / 30.9 / 9.0 / Death certificates / 1,039 / Age, sex, race, education, smoking, leisure-time physical activity, saturated fat intake, and LDL cholesterol
Tanomsup 200727 / To assess which components of the MetS are more strongly associated with CVD, whether other combinations of the components have stronger associations and the role of WC in the definition of MetS / Thailand / Electricity Generating Authority of Thailand (EGAT) Study. / General population (men and women) / 3,216 / 35-54 / NCEP-R / 19.3 / 17 / Standard criteria for confirmation by a committee / 309 / Age, smoking status, alcohol, physical activity and income
Simons 200735 / Assessed whether a diagnosis of the MetS improves the prediction of CVD or total mortality / UK / Dubbo Study / General population (men and women) / 2,805 / 60+ / NCEP-R (substituting BMI for WC) / 32.8 / 16 / Hospitalization and local death records with postal surveys conducted every 2 years / 1,387 / Age, smoking, alcohol, high BP therapy and prior CHD
Niwa 200733 / Clarified the prevalence of MetS and its effects to mortality / Japan / JichiMedicalSchool Cohort Study / Rural general population (men and women) / 2,176 / 56.1±12.2 / Japanese definition / 4.8 / 12.5 / Death certificates / 220 / Age, smoking, alcohol
Benetos et al, 200829 / Assessed the risk of all-cause and CVD mortality in subjects / France / General population (men and women) / 84,730 / 52.8±8.6 / NCEP / 9.6 / 4.7 / National death certificate / 104 / Age, sex, smoking, physical activity, LDL cholesterol, and socio-professional category
Lee 200834 / Assessed the effect of the MetS on all-cause and CVD mortality / Singapore / Singapore Cardiovascular Cohort Study / General population (men and women) / 5,699 / 23-62 / NCEP-R (substituting BMI for WC) / 22.8 / 14.1 / National Death Register / 3,802 / Age, study, race, LDL-C, smoking and alcohol.
Huang 200840 / Investigated the relationship between mortality and MetS / Taiwan / General population (men and women) / 124,513 / 20-94 / NCEP-R / 22.4 / 8 / National Death Register / 2,762 / Age, smoking, alcohol and physical activity
Mozaffarian 200841 / Evaluated relationships of MetS and individual MetS criteria with mortality / US / General population (men and women) / 4,258 / 73±5 / NCEP-R / 34.95 / 15 / Mortality review committee / 2,116 / Age, sex, race, education, smoking, smoking history, physical activity, and alcohol.
Tsai 200817 / Assessed the CVD mortality risks / Taiwan / Civil servants and teachers who took the annual physical examination (men and women) / 35,259 / 35.5-68 / NCEP (substituting BMI for WC) / 10.6 / 15 / Computerized national death files / 2,095 / Age, sex and smoking
Hsu 200832 / Explored the predictive values on the all-cause and cardiovascular mortality and the future risks of hypertension and diabetes of the MetS / Taiwan / General population (men and women) / 11,058 / 30-75.5 / NCEP (substituting WC from Asian criteria for WC) / 25.2 / 10.6 / National Death Registry based on the certified death certificates / 942 / Age and smoking
Zambon et al, 200942 / Explored the association of MetS and each of its components with all-cause and cardiovascular mortality / Italy / Progetto Veneto Anziani (Pro.V.A.) Study / General population (men and women) / 2,910 / 74±7 / NCEP / 39.0 / 4.4 / Official death certificates / 632 / Age, sex, smoking, physical activity, major diseases, BMI, albumin and LDLcholesterol

BMI: body mass index

CHD: coronary heart disease

CVD: cardiovascular disease

LDL: low-density-lipoprotein

MetS: metabolic syndrome

NCEP: the National Cholesterol Education Program Adult Treatment Panel III

NCEP-R: revised NCEP;

WC: waist circumference

WHO: World Health Organization

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10/6/2018