The metabolic syndrome: A critical appraisal based on the CUORE epidemiologic study

Simona Giampaoli*, Jeremiah Stamler, Chiara Donfrancesco, Salvatore Panico, Diego Vanuzzo, Giancarlo Cesana, Giuseppe Mancia, Lorenza Pilotto, Amalia Mattiello, Paolo Chiodini, Luigi Palmieri

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Objectives: Multiple aspects of the metabolic syndrome (MetS) remain problematic. Here we assess the association between epidemic obesity and the other MetS traits, and MetS utility for cardiovascular disease (CVD) risk assessment. Methods: Italian population-based Progetto CUORE data were used: 17 252 women and men ages 35-69 years, baseline 1984-1993, mean follow-up of 10 years, for nonfatal plus fatal CVD events. NCEP-ATP III criteria defined MetS. Results: Epidemic obesity was strongly related to epidemic rates of the four other MetS traits. Only four of 16 possible MetS trait combinations were common; their CVD hazard ratios ranged from 1.21 to 1.70. In multivariate analyses MetS was no better than the sum of its parts in predicting CVD, important information was lost due to omission of non-HDL-C and smoking, and from considering MetS traits as yes/no variables. CVD risk prediction by MetS was less strong for men and no stronger for women than by classical risk factors (blood pressure, diabetes, serum cholesterol, smoking, overweight/obesity). Conclusions: These findings are concordant with the inference that epidemic obesity importantly influences epidemic occurrence of the other MetS traits; they also indicate that use of MetS for CVD risk assessment has limitations and needs critical reconsideration.

Original languageEnglish (US)
Pages (from-to)525-531
Number of pages7
JournalPreventive medicine
Issue number6
StatePublished - Jun 2009


  • CUORE Project
  • Cardiovascular risk assessment
  • Metabolic syndrome
  • Prospective epidemiologic study

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Epidemiology


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