All metabolic risk factors at baseline and follow-up (i.e., systolic and diastolic blood pressures, HDL cholesterol, triglyc- erides, 2-h glucose, and insulin) were standardized by calculating Z scores based on the baseline distribution, sepa rately for men and women. We also con- structed a standardized continuously distributed variable for clustered meta- bolic risk, which we have previously de scribed in detail (24,25). This variable was derived by standardizing and then summing the following continuously dis- tributed indexes to create a Z score: hy pertension (lsystolic blood pressure diastolic blood pressure]/2), 2-h plasma glucose, fasting insulin, inverted fasting HDL cholesterol, and triglycerides.