The Metabolic Syndrome and the Impact of Diabetes on Coronary Heart Disease Mortality in Women and Men: The San Antonio Heart Study

Kelly J. Hunt, Ken Williams, Helen P. Hazuda, Michael P. Stern, Steve M. Haffner

Research output: Contribution to journalArticle

30 Scopus citations


Purpose: An explanation for the differential impact of diabetes on coronary heart disease (CHD) mortality in men and women is that diabetes and cardiovascular disease (CVD) share a common antecedent that differentially affects men and women. In the San Antonio Heart Study we examined the relationship between gender, the metabolic syndrome defined by the National Cholesterol Education Program (NCEP-MetS) and diabetes and their ability to predict CHD mortality. Methods: Over 15.5 years, 4996 men and women 25 to 64 years of age experienced 254 cardiovascular deaths, including 121 from CHD (International Classification of Diseases, Ninth Revision codes 410-414). Results: At baseline, NCEP-MetS occurred more often in men than in women among those with normal glucose levels (12.3% vs. 9.7%, p < 0.05), but less often in men than in women among those with diabetes (65.7% vs. 74.4%, p < 0.05). Adjusted for age, ethnic group, and a history of CVD, relative to women with neither diabetes nor NCEP-MetS, women with both had a 14-fold (hazard ratio [HR] = 14.3 [95% confidence interval: 6.62, 30.7]) increased risk of CHD mortality, whereas men had only a 4-fold (HR = 4.21 (95% confidence interval: 2.32, 7.65]) increased risk, respectively. Conclusion: When diabetes occurred with NCEP-MetS, gender was a strong modifier of the joint effect of diabetes and NCEP-MetS on CHD mortality.

Original languageEnglish (US)
Pages (from-to)870-877
Number of pages8
JournalAnnals of Epidemiology
Issue number11
Publication statusPublished - Nov 1 2007



  • Coronary Disease
  • Diabetes Mellitus, Type 2
  • Epidemiology
  • Gender
  • Metabolic Syndrome X
  • Mortality
  • Risk Factors

ASJC Scopus subject areas

  • Epidemiology

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