LOWERING ARM (ASCOT-BPLA) INVESTIGATORS

OBJECTIVE — To evaluate whether in hypertensive patients the risk of cardiovascular dis-ease is greater in association with the metabolic syndrome (MetS) or the sum of its individual components. RESEARCH DESIGN ANDMETHODS — Cox regression analysis models were devel-oped to assess the influence of age, sex, ethnicity, and the individual components of MetS on risk associated with the MetS (using several definitions) of coronary outcomes, stroke, and all-cause mortality. RESULTS — MetS was significantly associated with coronary outcomes, stroke, and all-cause mortality after adjusting for age, sex, and ethnicity. However, when the model was further adjusted for the individual components, MetS was associated with significantly increased risk of stroke (hazard ratio 1.34 [95 % CI 1.07–1.68]) and all-cause mortality (1.35 [1.16–1.58]) but not coronary outcomes (fatal coronary heart disease plus nonfatal myocardial infarction 1.16 [0.95–1.43] and total coronary events 1.06 [0.91–1.24]). CONCLUSIONS — MetS, independent of its individual components, is associated with increased risk of stroke and all-cause mortality but not coronary outcomes. Diabetes Care 33:1647–1651, 2010 S tudies in the recent past evaluatingthe usefulness of the metabolic syn-drome (MetS) have provided equiv-ocal results (1–4). The database from the blood pressure–lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) (5) provides an excellent opportunity to evaluate whether in hy-pertensive patients the risk of cardiovas-cular (CV) disease and death is greater in association with the MetS or the sum of its individual components. RESEARCH DESIGN AND METHODS — Details of the study de-sign and methods of the ASCOT-BPLA have been described previously (5). Definitions BMI30 kg/m2 was used instead of waist circumference in defining MetS because waist circumference was not measured in ASCOT-BPLA. The original Nationa