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Background  We wanted to explore the association of metabolic syndrome (MetS) versus its individual components with 20‐year all‐cause mortality among patients with stable coronary artery disease.    Methods and Results  The cohort comprised 12 403 nondiabetic patients with stable coronary artery disease who were enrolled in the Bezafibrate Infarction Prevention Registry between February 1990 and October 1992 and followed up through December 2014. The study cohort was divided into 4 groups: patients without MetS or impaired fasting glucose ( IFG ), patients with  IFG  but without MetS, patients with MetS but without  IFG , and patients with both MetS and  IFG . Kaplan‐Meier survival analysis showed that at 20 years of follow‐up, the rates of all‐cause mortality were the highest among patients with both MetS and  IFG  (66%). Patients with  IFG  without MetS experienced a significantly higher mortality rate compared with those with MetS without  IFG  (61% versus 56%; log‐rank  P <0.001). Multivariable Cox proportional hazard analysis showed that the final Cox model demonstrated that the additive effect of MetS (hazard ratio, 1.13; 95% confidence interval, 1.1–1.16;  P =0.02) and  IFG  (hazard ratio, 1.54; 95% confidence interval, 1.46–1.62;  P <0.001) on 20 years mortality was nonsignificant (hazard ratio, 1.01; 95% confidence interval, 0.93–1.11;  P =0.69).  IFG  was associated with the most pronounced increase in mortality risk among the individual components (hazard ratio, 1.22; 95% confidence interval, 1.14–1.3;  P <0.001).    Conclusions  Our findings suggest that  IFG  alone is a major independent predictor of long‐term mortality among patients with stable coronary artery disease versus other components of the MetS.

journal of the american heart association

Impaired Fasting Glucose Is the Major Determinant of the 20‐Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery Disease