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Is the Diagnosis of Metabolic Syndrome Useful for Predicting Cardiovascular Disease in Asian Diabetic Patients?

Analysis from the Japan Diabetes Complications Study

¹ Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Tsukuba, Japan
² Department of Biostatistics, Epidemiology and Preventive Health Sciences, University of Tokyo, Tokyo, Japan
³ Training Department of Administrative Dietician, Shikoku University, Tokushima, Japan
⁴ Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan
⁵ Department of Endocrinology and Metabolism, Jichi Medical College, Tochigi, Japan
⁶ Fourth Department of Medicine, Saitama Medical School, Saitama, Japan
⁷ Department of Internal Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
⁸ Tama-Hokubu Medical Center, Tokyo, Japan
⁹ Institute for Adult Diseases Asahi Life Foundation, Tokyo, Japan

Address correspondence and reprint requests to Nobuhiro Yamada, MD, PhD, Professor, Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan 305-8575. E-mail: jdcstudy{at}md.tsukuba.ac.jp

OBJECTIVE—The metabolic syndrome (MetS) is believed to be associated with an increased risk of cardiovascular disease (CVD). Although its prevalence is extremely high among diabetic patients, its prevalence in those with no history of CVD has not been determined. Moreover, prospective studies published on the association between MetS and cardiovascular events in diabetic populations have used only the World Health Organization (WHO) definition of MetS and included only white European subjects. The aim of this study was to determine the prevalence of MetS, as defined by both the WHO and the National Cholesterol Education Program (NCEP), and its predictive value for CVD in Asian diabetic patients in a long-term, prospective setting.

RESEARCH DESIGN AND METHODS—The baseline characteristics and incidence/hazard ratio of cardiovascular events (coronary heart disease and stroke) were determined in 1,424 Japanese type 2 diabetic patients with and without MetS, as defined by WHO (WHO-MetS) or the NCEP.

RESULTS—A high prevalence (38–53%, depending on sex and definition) of MetS was found among diabetic patients, even those with no history of CVD. During the 8-year study period, only WHO-MetS was a predictor for CVD in female patients. In male patients, although both definitions of MetS were significant predictors for CVD, individual components of MetS, such as hyperlipidemia or hypertension, were equivalent or better predictors.

CONCLUSIONS—We found that MetS is relatively common in diabetic patients with no history of CVD. We suggest that the commonly used definitions of MetS, at least in their present forms, have limited clinical usefulness for Asian diabetic patients and may need some ethnic group–specific modifications for global use.

Abbreviations: CHD, coronary heart disease • CVD, cardiovascular disease • ECG, electrocardiogram • HOMA-IR, homeostasis model assessment of insulin resistance • JDCS, Japan Diabetes Complications Study • MetS, metabolic syndrome • NCEP, National Cholesterol Education Program • UKPDS, U.K. Prospective Diabetes Study • WHO, World Health Organization • WHR, waist-to-hip ratio

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