Sleep disturbances and a risk of myocardial infarction

The aim of the study was to investigate the influence of sleep disturbances on the 8-year risk of myocardial infarction (MI) in men aged 25 to 64 years old. Screening of male inhabitants of one of Novosibirsk districts, aged 25 to 64 years, was performed within the framework of the WHO MONICA-psychosocial program in 1994. The cohort was followed up during 8 years (1994 - 2002) to determine end-points (MI). The statistical analysis was performed using SPSS- 10 software package. The relative risk (RR) of MI was evaluated using Cox proportional regressive model. Only one third of the 25 to 64-year-old male subjects with the first MI referred to their sleep as "good" whereas two thirds had sleep disturbances. The 8-year RR of MI in men aged 25 to 44 was 9.25 times higher in those whose sleep was estimated as '"poor" vs. those with "good" sleep, i. e. in this age group sleep disturbances were one of the most important MI risk factors; in 45 to 64 age group these differences were insignificant. RR of IM in men with sleep disturbances was higher in widowers, divorced men, men with low social support level, men with only primary education, working class men, and pensioners. The results demonstrate that sleep disturbances present a social problem and contribute greatly to the risk of MI in men of young age group.     

Study of myocardial infarction risk factors within the framework of the WHO Monica-psychosocial program

Three screening population studies were carried out within the framework of the WHO MONICA-psychosocial program in 1984, 1988, and 1994. The subjects of the study were male inhabitants of one of Novosibirsk districts aged 25 to 64 years. The cohort was studied during 18 years, from 1984 to 2002, using the WHO Acute Myocardial Infarction Register program. The statistical analysis was performed using SPSS-10 software package. The relative risk (RR) of myocardial infarction (MI) was estimated using Cox proportional regressive model. The greatest proportion (38.9%) of patients with MI was among men aged 45 to 54 years. Among men with MI, 58.7% had a high personal anxiety (PA) level. RR of MI was high among widowers, divorced and single men with a high PA level, in men with incomplete secondary or primary education, and men of hard or moderate physical labor. In the age group of 24 to 44, RR of MI during the first 5 and 10 years was 7.5 times higher in men with a high PA level vs. men with a medium PA level (p < 0.01). This explains the bigger number of men with MI in the group of 45 to 54 years of age.     

Risk of arterial hypertension and social support

The aim of the study was to investigate the effect of social support on the 8-year risk of arterial hypertension (AH) in men aged 25 to 64. The researchers studied a random representative sample of male residents of a Novosibirsk district aged 25 to 64 years. The level of social support was evaluated by Berkman-Syme method. All the cases of AH which occurred in the cohort within 8 years (1994-2002) were investigated. The statistical analysis was performed using SPSS-11.5 software package. The relative risk (RR) of AH was evaluated using a Cox proportional regressive model. Within these 8 years the RR of AH was higher: 1) in men aged 25 to 64 years with low and medium close contact index (CCI) compared to men with high CCI (8.5 times); 2) in subjects with low social contact index (SCI) compared to subjects with high or medium SCI (4.8 times). In men aged 55 to 64 years the RR of AH was 15.9 times higher in men with low CCI. The highest rate of AH was found in men with low CCI and SCI belonging to the groups of widowers, divorced people, subjects with incomplete secondary or primary education, as well as in pensioners and people with low level of social support. The results show that AH risk in men aged 25 to 64 years is associated with low level of social support.     

An 8-year study of depression effects on myocardial infarction risk in a population of 25-64 year old men

AIM: To study depression effects on the risk of myocardial infarction (MI) for 8 years in men aged 25-64 years. MATERIAL AND METHODS: A random representative sample of men (n = 657) at the age between 25 and 64 living in Novosibirsk were screened in 1994 in the scope of WHO program "MONICA-psychosocial". The response was 82.1%. WHO "Register of Acute Myocardial Infarction" detected 58 cases of MI in the control period 1994-2002. Statistics were obtained with the program set SPSS-10. Cox regression model was used for estimation of a relative MI risk (RMIR). RESULTS: RMIR in 25-64-year-old men for 8 years was 2-fold higher in men with depression than without it, in the age group of 55-64-old men--5-fold. Depression was in 65.8% MI patients. The highest RMIR was in men with depression engaged in hard labour, retired, poorly educated, divorced, widowed. CONCLUSION: Risk of MI in men is related to depression due to social and economic status.     

Effects of hostility on the risk of arterial hypertension, myocardial infarction, stroke in a sample of males aged 25-64 years (epidemiological trial on the base of WHO program MONICA)

AIM: To study effects of hostility on the risk of arterial hypertension (AH), myocardial infarction (MI) and stroke in males aged 25-64 years. MATERIALS AND METHODS: A screening study of the population was performed in 1994 according to WHO program MONICA-psychosocial. The response in a random representative sample of 25-64-year-old males (n = 657) living in Novosibirsk was 82.1%. New cases of MI, AH and stroke were registered in the control periods 1994-2000, 1994-2002. Computer program package SPSS-10 was used for statistic processing. Cox regression model of the relative risk (RR) was employed. RESULTS: Hostility was rather prevalent among the examinees (76.9%). MI risk for 8 years was 4.65 times higher in hostile men. Hostility was not associated with higher risk of AH and stroke. Hostility was seen more frequently in men with poor education, workers and retired persons. These groups are also at the highest risk of MI. CONCLUSION: Hostility raises MI risk in unstable society but had no effect on the risk of AH and stroke.     

20-year monitoring of acute cardiovascular diseases in population of large industrial city in West Siberia (epidemiological study)

AIM: To reveal trends in incidence rates of acute cardiovascular diseases (ACD) in a large industrial city of the West Siberia. MATERIALS AND METHODS: Studies on WHO programs "Acute Myocardial Infarction Register" and "MONICA" have been performed in three districts of Novosibirsk. The diagnostic categories were detected without difference. The observation covered stable population of 500,000 residents aged 25-64 years. Trends in the myocardial infarction (MI) mortality, morbidity and lethality were analysed for 1977-1996. RESULTS: The above trends were stable except for 1986 when MI mortality, morbidity and lethality decreased and 1988 and 1994 when they went up. The reduction was due to 7-year prevention program while the rise was consequent to discontinuation of the preventive measures. Major risk factors of ischemic heart disease, according to screenings conducted in 1984, 1988 and 1994 remained at about the same level. Social stress closely correlates with a rise in MI morbidity and mortality. The latter in 1994 grew owing to higher rates of MI mortality and morbidity among the oldest men and females of different age groups. CONCLUSION: Urgent intensification of prophylactic measures is needed both at the populational level and the level of high risk strategy.     

Monitoring myocardial infarct (diagnostic combination,prodromal period,behavioral characteristics) using the WHO program "Registry of Acute Myocardial Infarct", Monica

AIM: A 22-year study of diagnostic categories of myocardial infarction (MI), a prodromal period, behavioral characteristics of the patients. MATERIAL AND METHODS: WHO programs Acute Myocardial Infarction Register and MONICA were performed in Novosibirsk population aged 25-64 years. From January 1, 1977, to December 31, 1998, monitoring registered 5180 cases of MI (1774 lethal outcomes). RESULTS: The diagnostic category "Possible" MI occurred more frequently than "definite" MI, this difference being more noticeable in women than in men. In both diagnostic categories the disease presented with a typical clinical picture. In the category "definite" MI there were many cases of atypical disease. Most cases of MI developed at home though it occurred outdoors more frequently in men and at home in women. Half of the patients had arterial hypertension (AH) and effort angina (EA), one third of the patients had survived MI before. 91% of MI men were heavy smokers. Alcohol intake at MI onset was insignificant. Pain syndrome 2 weeks before MI was the same in survivors and the deceased. Those who died suddenly felt extremely tied before MI, those whose death was not sudden experienced exacerbation of EA and dyspnea, those who survived experienced exacerbation of EA. CONCLUSION: Long-term monitoring showed that MI clinical presentation did not differ for 2 decades. A significant number of MI patients with a history of hypertension, effort angina, previous MI, heavy smoking evidenced for the lack of prophylactic education among population.     

Cardiovascular morbidity and mortality associated with the metabolic syndrome

OBJECTIVE: To estimate the prevalence of and the cardiovascular risk associated with the metabolic syndrome using the new definition proposed by the World Health Organization RESEARCH DESIGN AND METHODS: A total of 4,483 subjects aged 35-70 years participating in a large family study of type 2 diabetes in Finland and Sweden (the Botnia study) were included in the analysis of cardiovascular risk associated with the metabolic syndrome. In subjects who had type 2 diabetes (n = 1,697), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) (n = 798) or insulin-resistance with normal glucose tolerance (NGT) (n = 1,988), the metabolic syndrome was defined as presence of at least two of the following risk factors: obesity, hypertension, dyslipidemia, or microalbuminuria. Cardiovascular mortality was assessed in 3,606 subjects with a median follow-up of 6.9 years. RESULTS: In women and men, respectively, the metabolic syndrome was seen in 10 and 15% of subjects with NGT, 42 and 64% of those with IFG/IGT, and 78 and 84% of those with type 2 diabetes. The risk for coronary heart disease and stroke was increased threefold in subjects with the syndrome (P < 0.001). Cardiovascular mortality was markedly increased in subjects with the metabolic syndrome (12.0 vs. 2.2%, P < 0.001). Of the individual components of the metabolic syndrome, microalbuminuria conferred the strongest risk of cardiovascular death (RR 2.80; P = 0.002). CONCLUSIONS: The WHO definition of the metabolic syndrome identifies subjects with increased cardiovascular morbidity and mortality and offers a tool for comparison of results from diferent studies.     

Migraine and coronary heart disease in women and men

OBJECTIVE: We evaluated migraine as an independent risk factor for subsequent coronary heart disease (CHD) events among women in the Women's Health Study (WHS) and men in the Physicians' Health Study (PHS). BACKGROUND: Although several studies have suggested that migraine is associated with increased risk of stroke, there are few and conflicting data on whether migraine predicts risk of future CHD events. METHODS: The WHS is an ongoing randomized, double-blind, placebo-controlled trial of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer in 39876 women health professionals aged > or =45 years in 1993, and the PHS is a completed randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in the primary prevention of cardiovascular disease and cancer in 22071 men physicians aged 40 to 84 years in 1982. Primary endpoints were defined as major CHD (nonfatal myocardial infarction [MI] or fatal CHD) and total CHD (major CHD plus angina and coronary revascularization). RESULTS: After adjusting for other CHD risk factors, female health professionals and male physicians reporting migraine were not at increased risk for subsequent major CHD (women: relative risk [RR], 0.83; 95% confidence interval [CI], 0.53 to 1.29; men: RR, 1.02; 95% Cl, 0.79 to 1.31) or total CHD (women: RR, 1.01; 95% Cl, 0.76 to 1.34; men: RR, 0.98; 95% Cl, 0.82 to 1.18). When considered separately, there was also no increase in risk of MI or angina. CONCLUSION: These prospective data suggest that migraine is not associated with increased risk of subsequent CHD events in women or men.     

Association of type and duration of diabetes with erectile dysfunction in a large cohort of men

OBJECTIVE: Differences in risk of erectile dysfunction (ED) by characteristics of diabetes among older men are not well understood. We examined the association of type and duration of diabetes with erectile function in men >50 years of age in a large prospective cohort study. RESEARCH DESIGN AND METHODS: Subjects included 31,027 men aged 53-90 years in the Health Professionals Follow-Up Study cohort. On a questionnaire mailed in 2000, participants rated their ability (without treatment) in the past 5 years to have and maintain an erection sufficient for intercourse. Men who reported poor or very poor function were considered to have ED. Diabetes information was ascertained via self-report and documented with supplementary medical data. RESULTS: Men with diabetes had an age-adjusted relative risk (RR) of 1.32 (95% CI 1.3-1.4) for having ED compared with men without diabetes. In multivariable regression analyses, men with type 1 and type 2 diabetes were at a significantly higher risk for ED (type 1 diabetes RR = 3.0, 95% CI 1.5-5.9; type 2 diabetes RR = 1.3, 1.1-1.5) than nondiabetic men. Men with type 2 diabetes had an increasingly greater risk of ED with increased duration since diagnosis (trend test P value <0.0001) (RR = 1.7, 95% CI 1.1-2.7, for men diagnosed >20 years previously). CONCLUSIONS: For men over age 50 years, increasing duration of diabetes was positively associated with increased risk of ED relative to nondiabetic subjects. This association persisted despite the higher prevalence of other comorbid conditions. ED prevention and diabetes management efforts are likely to go hand-in-hand.     

Ventricular Gradient as a Risk Factor in Survivors of Acute Myocardial Infarction

BATCHVAROV, V., et al. : Ventricular Gradient as a Risk Factor in Survivors of Acute Myocardial Infarction. The total cosine between R and T (TCRT) (angular difference between the spatial QRS and T wave loops) is a technical elaboration of the concept of ventricular gradient (VG), whose power as a risk stratifier in post-MI patients has already been demonstrated. Recently, it was reported that TCRT differed significantly between healthy men and women, which suggested that its predictive power might be gender dependent. The aim of the study was to investigate TCRT and its association with cardiac mortality in male and female survivors of acute MI. TCRT was measured from digital Frank orthogonal XYZ-lead ECGs recorded before hospital discharge in 681 survivors of acute MI (82% men, age: men   57.0 ± 8.4 years   , women   59.6 ± 8.1 years, P = 0.002   ). During a follow-up censored at 5 years, cardiac mortality rates were 9.7% and 12.1% in men and women, respectively   (P = 0.42)   . There were no significant difference in TCRT between men and women (  −0.150 ± 0.704  vs   −0.070 ± 0.731, P = 0.26   ). In univariate Cox regression analysis, TCRT   < −0.88   was related to a 5-year cardiac mortality in men (relative risk [RR] 3.67, 95% confidence interval [CI]   2.13–6.34, P = 1.9 × 10 ⁻⁶   ), and women   (RR 5.16, 95% CI 1.83–14.56, P = 0.0015)   . Depressed TCRT was strongly associated with increased long-term cardiac mortality in survivors of acute MI. Its predictive power did not differ significantly between the sexes. The role of TCRT as a risk-stratifier in post-MI patients deserves further prospective assessment in multivariate models with established risk factors. (PACE 2003; 26[Pt. II]:373–376)     

Alteration of the QT/RR Relationship in Patients with Idiopathic Ventricular Tachycardia

It has been shown that alterations in QT/RR relationship may be associated with arrhythmogenesis in several clinical settings. In the present study the QT/RR relationship was studied in 20 patients with idiopathic ventricular tachycardia (12 men and 8 women, aged 41±14 years) compared to 20 normal subjects (9 men and 11 women, aged 39 ± 13 years). All the patients were off any antiarrhythmic drugs and had no evidence of intraventricular conduction defects. The QT intervals and their preceding RR intervals were measured on electrocardiogram strips from 24-hour Holter tapes at hourly intervals. The differences in the maximum, minimum, and mean of either the QT interval or its corrected values between patients with idiopathic ventricular tachycardia and normal subjects were not statistically significant. There was a significant correlation between the QT and RR intervals in normal subjects (γ= 0.73 ± 0.12, P < 0.05) and in patients with idiopathic ventricular tachycardia (γ= 0.80 ± 0.10, P < 0.05). However, the linear regression line of the QT interval against the RR interval were significantly (P < 0.001) altered in patients with idiopathic ventricular tachycardia (QT = 0.24 + 0.18 RR) compared to normal subjects (QT = 0.27 ± 0.12 RR). We conclude that although there is no significant change in the QT interval and its corrected values, the QT/RR relationship is significantly altered in patients with idiopathic ventricular tachycardia as compared to normal subjects. This may be of importance in the pathogenesis of idiopathic ventricular tachycardia in these patients.     

High-sensitivity C-reactive protein and coronary heart disease mortality in patients with type 2 diabetes: a 7-year follow-up study

OBJECTIVE: To investigate in a follow-up study whether high-sensitivity C-reactive protein (hs-CRP) predicts coronary heart disease (CHD) events in subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS: The original study population consisted of 1,059 patients with type 2 diabetes (age 45-64 years). Mean duration of diabetes was 8 years. CRP values were available from 1,045 subjects, of whom 878 were free of myocardial infarction (MI) at baseline. CHD mortality and the incidence of nonfatal MI were assessed in a 7-year follow-up. RESULTS: Altogether, 157 patients died from CHD and 254 had a nonfatal or fatal CHD event. Patients with hs-CRP >3 mg/l had a higher risk for CHD death than patients with hs-CRP < or =3 mg/l (19.8 and 12.9%, respectively, P = 0.004). In Cox regression analysis, patients with high hs-CRP had a relative risk of 1.72 for CHD death even after the adjustment for confounding factors (P = 0.002). Among subjects who were free from MI at baseline, those with a high hs-CRP level had relative risks of 1.83 (P = 0.003) and 1.84 (P = 0.004) for CHD death in univariate and multivariate analyses, respectively. CONCLUSIONS: In this large cohort of type 2 diabetic patients, hs-CRP was an independent risk factor for CHD deaths.     

Chronic daily headache in Taipei, Taiwan: prevalence, follow-up and outcome predictors

We conducted a two-stage population-based headache survey among subjects aged > or = 15 in Taipei, Taiwan. Subjects with chronic daily headache (CDH) in the past year were identified, interviewed and followed-up. CDH was defined as a headache frequency > 15 days/month, with a duration > 4 h/day. Of the 3377 participants, 108 (3.2%) fulfilled the criteria for CDH, with a higher prevalence in women (4.3%) than men (1.9%). TM was the most common subtype (55%), followed by CTTH (44%). Thirty-four per cent of the CDH subjects overused analgesics. At the 2-year follow-up, 35% of the CDH subjects still had CDH. The significant predictors for persistent CDH at follow-up included: older age ( > or = 40 years) (RR = 2.4), CDH onset after 32 years (RR = 1.8), CDH duration > or = 6 years (RR = 2.0), medication overuse (RR = 1.8), and "daily" headache (RR = 2.1). We found that CDH is not uncommon in the community and its prevalence is similar among different populations. Older subjects and those with medication overuse may have a more protracted course of illness.     

Relationships of fasting and postload glucose levels to sex and alcohol consumption. Are American Diabetes Association criteria biased against detection of diabetes in women?

OBJECTIVE: To compare, in men and women, the prevalence of undiagnosed type 2 diabetes assessed using criteria from the American Diabetes Association (ADA) and the World Health Organization (WHO) and to investigate risk factors associated with fasting and 2-h postload plasma glucose. RESEARCH DESIGN AND METHODS: Data from two companion surveys of Europeans, South Asians, and Afro-Caribbeans in west London were used. A total of 4,367 men and women aged 40-64 years who were not known to have diabetes underwent an oral glucose tolerance test after an overnight fast. The prevalence of undiagnosed diabetes was estimated using the ADA (fasting plasma glucose > or = 7.0 mmol/l) and WHO (2-h postload glucose > or = 11.1 mmol/l) criteria for epidemiologic studies. The association of body fat and usual alcohol intake with plasma glucose and diabetes prevalence was assessed. RESULTS: Compared with the WHO criterion, the ADA criterion gave a higher prevalence of diabetes in men (6.4 vs. 4.7%) but a lower prevalence in women (3.3 vs. 4.2%). In Afro-Caribbeans, the sex difference in diabetes prevalence was reversed. Women had significantly lower fasting glucose than men despite higher 2-h glucose levels. Alcohol intake was positively associated with fasting glucose in men and women but not with 2-h glucose levels. CONCLUSIONS: The new ADA criterion, based on fasting glucose alone, does not take account of sex differences in metabolic response to fasting or possible artifactual effects on fasting glucose. With the ADA criterion, alcohol intake was a significant risk factor for diabetes in our study population; this was not the case with the WHO criterion.     

Heart Rate Variability in Myocardial Infarction With and Without Malignant Arrhythmias: Comparison with Heart Transplant Recipients and Normal Subjects

Myocardial autonomic denervation occurs after acute MI. This process is followed by a reduction of heart rate variability (HRV) and an increase of malignant ventricular arrhythmias and sudden death. This study investigated whether there are any significant differences in HRV among the population of MI who did and did not have malignant ventricular arrhythmias (MVAs), normal subjects and heart transplant recipients, the paradigm of the denervated heart. We studied 25 subjects aged 42 ± 17 years, with normal clinical and cardiac noninvasive evaluation (group A); 70 patients aged 57 ± 14 years, who had MI hut no arrhythmic event in 36 months of follow-up (group B); 13 patients with MI aged 65 ± 9 years, who had had sustained VT, VF, or sudden death (group C); and 16 cardiac transplant recipients aged 35 ± 14 years (group D). The ECG was sampled for 256 seconds. We calculated, in time and frequency domain, the standard deviation of the RR cycle length and the spectral component's very low frequency (< 0.05 Hz), low frequency (0.05–0.15 Hz), and high frequency (0.15–0.35 Hz). The values of HRV in group A were significantly greater than in groups B, C, and D (P < 0.001) and greater in group B than in groups C and D (P < 0.001). Groups C and D did not differ (P = 0.610). These data indicate that HRV of patients who have had an MI and MVAs is very similar to that of heart transplant recipients. This is an indirect evidence that myocardial autonomic denervation may play an important role in the genesis of malignant arrhythmic events.     

Chest pains detected on the basis of the WHO standard questionnaire and their prognostic significance

A WHO standard questionnaire for the detection of angina pectoris was used in examination of 6914 males aged 40 to 59. The character of the pain syndrome was correlated with risk factor (RF) levels, the prevalence of ECG-signs of ischemic changes, the incidence of cases of myocardial infarction (MI) during a 5-year follow-up period. Examinees with angina pectoris had the highest levels of systolic and diastolic AP, cholesterol, body mass, the highest frequency of lethal and nonlethal MI. Examinees with chest pains resulting from physical exercise but atypical of angina had higher levels of the main RF and ECG-signs of ischemic changes and higher rates (2-fold) of new cases of MI and its mortality as compared to persons without chest pains or with pains unrelated with physical exercise during a 5-year prospective study. This evidence suggests a necessity of a more detailed investigation of the latter group to reach the entire group of CHD patients.     

Alcohol consumption and mortality among kaunas population aged 35-64 years from 1983 to 2002

AIM: To evaluate time trends in alcohol consumption habits and alcohol-related mortality among Kaunas (Lithuania) population aged 35--64 years from 1983 to 2002. MATERIAL AND METHODS: The WHO MONICA study was carried out in Kaunas from 1983 to 2002. Alcohol consumption habits were determined using the data of four surveys among random samples of population aged 35-64 years (overall 3292 men and 3548 women, the response rate 65.1%). The source of mortality data is official mortality statistics of all permanent residents of Kaunas aged 35-64 years in 1983-2002. Age-standardized rates were calculated by the direct method and using World population as a standard. The trends were analyzed using the method of linear regression on logarithms of the age-standardized annual rates. RESULTS: Over the 20 years, the prevalence of regular alcohol consumption significantly increased among both men and women. At the same time, there was an increase in the study population of a mean level of consumed alcohol and the proportion of drinkers consuming alcohol frequently. During 1983 to 2002 mortality rates from external causes and suicides were increasing significantly among men (by 2.1%/yr., p = 0.039 and by 3.4%/yr., p = 0.0002, respectively) and have not changed among women. CONCLUSION: Negative trends in alcohol consumption habits and alcohol-related mortality among urban Lithuanian population aged 35-64 years during the past 20 years were determined.     

10-year dynamics of attitude to health problems in the male population of Novosibirsk (epidemiological study based on the WHO MONICA program)

AIM: To evaluate changes for a decade in the attitude of men in Novosibirsk to health problems. MATERIAL AND METHODS: WHO program MONICA has covered males aged 25-64 years (a representative sample from the population in one of the districts of Novosibirsk city). A total of 3 trials were made (in 1984, 1988 and 1994) which included questioning, registration of ECG, arterial pressure, height, body mass, biochemical tests of the blood. RESULTS: Attitude of men to their health depended on their age. There was a trend to evaluate their health as more and more poor in men at the age of 25-43 and 35-44 years. In the group of 45-54-year-olds positive assessment of health was encountered 1.9 times more frequently, but the difference was not significant. At the age 55-64 years a growing number of men tend to assess their health as good. Since 1994 alcoholics among the elderly men grew in number as a response to the social and economic crisis. CONCLUSION: The change in health evaluation from negative to positive in older men may relate to less intensive work.     

The National Cholesterol Education Program - Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes

OBJECTIVE: The clinical value of metabolic syndrome is uncertain. Thus, we examined cardiovascular disease (CVD) and diabetes risk prediction by the National Cholesterol Education Program (NCEP)-Adult Treatment Panel III (ATPIII), International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome. RESEARCH DESIGN AND METHODS: We analyzed the risks associated with metabolic syndrome, the NCEP multiple risk factor categories, and 2-h glucose values in the San Antonio Heart Study (n = 2,559; age range 25-64 years; 7.4 years of follow-up). RESULTS: Both ATPIII metabolic syndrome plus age > or = 45 years (odds ratio 9.25 [95% CI 4.85-17.7]) and multiple (two or more) risk factors plus a 10-year coronary heart disease (CHD) risk of 10-20% (11.9 [6.00-23.6]) had similar CVD risk in men without CHD, as well as CHD risk equivalents. In women counterparts, multiple (two or more) risk factors plus a 10-year CHD risk of 10-20% was infrequent (10 of 1,254). However, either a 10-year CHD risk of 5-20% (7.72 [3.42-17.4]) or ATPIII metabolic syndrome plus age > or = 55 years (4.98 [2.08-12.0]) predicted CVD. ATPIII metabolic syndrome increased the area under the receiver operating characteristic curve of a model containing age, sex, ethnic origin, family history of diabetes, and 2-h and fasting glucose values (0.857 vs. 0.842, P = 0.013). All three metabolic syndrome definitions imparted similar CVD and diabetes risks. CONCLUSIONS: Metabolic syndrome is associated with a significant CVD risk, particularly in men aged > or = 45 years and women aged > or = 55 years. The metabolic syndrome predicts diabetes beyond glucose intolerance alone.