Metabolic Syndrome and Cardiovascular Risk in Elderly Treated Hypertensive Patients.

Background: The independent prognostic significance of the metabolic syndrome (MetS) in the elderly is not yet clear. We investigated the association between MetS and cardiovascular risk (composite endpoint of stroke and coronary events) in elderly treated hypertensive patients. Methods: Cardiovascular outcome was evaluated in 1191 elderly treated hypertensive patients (>60 years). Among them, 578 (48.5%) had MetS according to a modified joint interim statement definition (body mass index in place of waist circumference). Results: During the follow-up (9.1  4.9 years, range 0.4-20 years), 139 strokes and 120 coronary events occurred. In univariate analysis, patients with MetS had higher risk of the composite endpoint (hazard ratio 1.322, 95% confidence interval 1.035-1.688, P <0.05). Among the single components of MetS, only blood pressure level and impaired fasting glucose/diabetes were significantly associated with increased cardiovascular risk. After adjustment for age, previous events, estimated glomerular filtration rate, left ventricular hypertrophy and left atrial enlargement, the prognostic relevance of MetS was attenuated (hazard ratio 1.245, 95% confidence interval 0.974-1.591, P = 0.08). After further adjustment for the abovementioned variables and ambulatory blood pressure parameters and impaired fasting glucose/diabetes, Cox regression analysis showed that MetS was not independently associated with increased cardiovascular risk (hazard ratio 1.090, 95% confidence interval 0.805-1.475, P = 0.58). Conclusions: In elderly treated hypertensive patients, MetS is associated with increased cardiovascular risk, but not independently of blood pressure and glucose levels and of organ damage.