The increased risk of HF with the metabolic syn- drome has consistently been demonstrated in other populations. In assessments of the contribution of the individual metabolic syndrome components to incident HF, the results vary slightly between studies, but over- all, obesity, hypertension, and an increased fasting glucose most strongly predicted incident HF. These risk factors had HRs similar to that of the metabolic syndrome as a whole, suggesting that the metabolic syndrome does not predict HF better than its individual components. Wang et al294 applied the World Health Organization, National Cholesterol Education Program, International Diabetes Federation, and AHA/National Heart, Lung, and Blood Institute definitions to a popu- lation of elderly Finns and found that each of them was predictive of incident HF. Both MESA199 and this study demonstrated that the metabolic syndrome predicts HF independently of MI, suggesting that it is also as- sociated with nonischemic HF. also demonstrate the important contribution of other typically unmeasured components of the metabolic syndrome, including inflammation and microalbuminuria (included in the World Health Organi- zation definition), to the development of HF. In CHS, a C-reactive protein level 3 mg/L and interleukin-6 level 2.21 pg/mL were significant predictors of incident HF and provided additive information when combined with the metabolic syndrome in predicting the development Moreover, in MESA, C-reactive protein, interleu- kin-6, fibrinogen, and microalbuminuria levels were sig- nificantly associated with incident HF. Although obesity ) was also an independent risk factor for the development of HF, its results were attenuated with the addition of interleukin-6 or C-reactive protein to the model, suggesting that the effects of obesity may be partially mediated through inflammatory pathways.199 Role of the Metabolic Syndrome in Patients With Established HF The prevalence and effects of the metabolic syndrome in the established HF population are less well studied. 