Gender‐ and race‐specific metabolic score and cardiovascular disease mortality in adults: A structural equation modeling approach—United States, 1988‐2006

Objective Consider all metabolic syndrome (MetS) components [systolic (SBP) and diastolic (DBP) blood pressures, waist circumference, HDL cholesterol, triglycerides (TG), and fasting glucose] and gender/race differential risk when assessing cardiovascular disease (CVD) risk. Methods We estimated a gender‐ and race‐specific continuous MetS score using structural equation modeling and tested its association with CVD mortality using data from National Health and Nutrition Examination Survey III linked with the National Death Index. Cox proportional hazard regression tested the association adjusted for sociodemographic and behavior characteristics. Results For men, continuous MetS components associated with CVD mortality were SBP (hazard ratio = 1.50, 95% confidence interval = 1.14‐1.96), DBP (1.48, 1.16‐1.90), and TG (1.15, 1.12‐1.16). In women, SBP (1.44, 1.27‐1.63) and DBP (1.24, 1.02‐1.51) were associated with CVD mortality. MetS score was not significantly associated with CVD mortality in men; but significant associations were found for all women (1.34, 1.06‐1.68), non‐Hispanic white women (1.29, 1.01‐1.64), non‐Hispanic black women (2.03, 1.12‐3.69), and Mexican‐American women (3.57, 2.21‐5.76). Goodness‐of‐fit and concordance were overall better for models with the MetS score than MetS (yes/no). Conclusions When assessing CVD mortality risk, MetS score provided additional information than MetS (yes/no).