Does the constellation of risk factors with and without abdominal adiposity associate with different cardiovascular mortality risk?

Aims: To evaluate whether the metabolic syndrome (MetS) defined by the International Diabetes Federation (IDF) criteria, which has abdominal adiposity as a mandatory element, predicts cardiovascular disease (CVD) mortality better than the cluster of other IDF-defined abnormalities not including abdominal adiposity. Methods: Data from nine European population-based studies, including 7782 men and 7739 women (aged 30–89 years), with a median follow-up of 8.55 years, were jointly analyzed. Hazard ratios for CVD mortality were calculated with Cox regression models. Results: In total, 41% of the men and 38% of the women had the IDF MetS. Individuals with the IDF MetS were by definition more obese and had a higher prevalence of diabetes than non-obese subjects with ⩾2 IDF abnormalities; whereas non-obese men with ⩾3 factors had more atherogenic lipid profiles. Multivariate adjusted hazard ratio for CVD death in men and women with the IDF MetS was 2.44 (1.69–2.98) and 2.32 (1.27–4.23); in non-obese men with 2 and ⩾3 factors the hazard ratio was 1.60 (1.12–2.30) and 2.44 (1.62–3.66), respectively, and in non-obese women with 2 factors the hazard ratio was 2.41 (1.09–5.33). Conclusions: The cluster of the CVD risk factors predicted CVD mortality regardless of the presence or absence of the abdominal adiposity. Inclusion of abdominal adiposity as a prerequisite will miss those non-obese individuals who have increased CVD mortality.