Previous studies
In a previous cross-sectional study based on the NHANES III
cohort,16 the presence of HF was significantly associated with
both the NCEP ATP III and World Health Organization
definitions of metabolic syndrome. To our knowledge, there
are no previous longitudinal studies of the predictive value of
metabolic syndrome for the incidence of subsequent HF. In a
recent study of the present cohort, insulin resistance,
measured with the reference standard euglycaemic insulin
clamp technique, was an independent risk factor for HF,
taking diabetes, obesity and other established HF risk factors
into account.17 The cumbersome euglycaemic insulin clamp
technique is unlikely ever to be used for clinical risk
evaluation. The present study, which investigated a clinically
feasible proxy for insulin resistance—that is, metabolic
syndrome—is therefore an important clinical extension of
that previous study and adds knowledge, as it examined a
larger study sample of middle-aged men with a longer follow
up.