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

Analysis from the Japan Diabetes Complications Study

  1. Hirohito Sone, MD, PHD, FACP1,
  2. Sachiko Mizuno, PHD2,
  3. Hitomi Fujii, MD2,
  4. Yukio Yoshimura, PHD, RD3,
  5. Yoshimitsu Yamasaki, MD, PHD4,
  6. Shun Ishibashi, MD, PHD5,
  7. Shigehiro Katayama, MD, PHD6,
  8. Yasushi Saito, MD, PHD7,
  9. Hideki Ito, MD, PHD8,
  10. Yasuo Ohashi, PHD2,
  11. Yasuo Akanuma, MD, PHD9,
  12. Nobuhiro Yamada, MD, PHD1 and
  13. the Japan Diabetes Complications Study Group*
  1. 1Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Tsukuba, Japan
  2. 2Department of Biostatistics, Epidemiology and Preventive Health Sciences, University of Tokyo, Tokyo, Japan
  3. 3Training Department of Administrative Dietician, Shikoku University, Tokushima, Japan
  4. 4Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan
  5. 5Department of Endocrinology and Metabolism, Jichi Medical College, Tochigi, Japan
  6. 6Fourth Department of Medicine, Saitama Medical School, Saitama, Japan
  7. 7Department of Internal Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
  8. 8Tama-Hokubu Medical Center, Tokyo, Japan
  9. 9Institute for Adult Diseases Asahi Life Foundation, Tokyo, Japan
  1. 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

Abstract

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.

Footnotes

  • H.S. and S.M. contributed equally to the study.

  • *

    ↵* A complete list of members of the Japan Diabetes Complications Study Group can be found in the appendix.

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted February 17, 2005.
    • Received December 3, 2004.
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  1. doi: 10.2337/diacare.28.6.1463 Diabetes Care June 2005 vol. 28 no. 6 1463-1471
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