Relationship Between Metabolic Risk Factor Clustering and Cardiovascular Mortality Stratified by High Blood Glucose and Obesity

NIPPON DATA90, 1990–2000

  1. Aya Kadota, MD12,
  2. Atsushi Hozawa, MD1,
  3. Tomonori Okamura, MD1,
  4. Takashi Kadowak, MD1,
  5. Koshi Nakmaura, MD1,
  6. Yoshitaka Murakami, PHD1,
  7. Takehito Hayakawa, PHD3,
  8. Yoshikuni Kita, PHD1,
  9. Akira Okayama, MD4,
  10. Yasuyuki Nakamura, MD5,
  11. Atsunori Kashiwagi, MD2,
  12. Hirotsugu Ueshima, MD1 and
  13. for the NIPPON DATA Research Group
  1. 1Department of Health Science, Shiga University of Medical Science, Otsu, Japan
  2. 2Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
  3. 3Department of Public Health Science, Shimane University, Izumo, Japan
  4. 4Department of Preventive Cardiology, National Cardiovascular Center, Suita, Japan
  5. 5Cardiovascular Epidemiology, Kyoto Women's University, Kyoto, Japan
  1. Address correspondence and reprint requests to Aya Kadota, MD, Department of Health Science, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Japan. E-mail: ayakd{at}belle.shiga-med.ac.jp

Abstract

OBJECTIVE—Metabolic syndrome is diagnosed according to several criteria. Of these, some require glucose intolerance and others require obesity for the diagnosis. We investigated the relationship between metabolic risk factor clustering and cardiovascular disease (CVD) mortality stratified by high blood glucose or obesity.

RESEARCH DESIGN AND METHODS—We followed 7,219 Japanese men and women without a history of CVD for 9.6 years. We defined high blood pressure, high blood glucose, high triglycerides, low HDL cholesterol, and obesity as metabolic factors. The multivariate adjusted hazard ratio (HR) for CVD mortality according to the number of clustering metabolic factors was calculated using the Cox proportional hazards model.

RESULTS—During follow-up, 173 participants died of CVD. The numbers of metabolic risk factors and CVD mortality were positively correlated (Ptrend = 0.07). The HR was obviously higher among participants with than among those without high blood glucose and clustering of ≥2 other metabolic risk factors (HR 3.67 [95% CI 1.49–9.03]). However, the risk increase was only modest in participants without high blood glucose even if they had ≥2 other metabolic risk factors (1.99 [0.93–4.28]). Conversely, metabolic risk factor clustering was related to CVD mortality irrespective of obesity.

CONCLUSIONS—Our findings suggest that glucose tolerance plays an important role in CVD mortality. Because the prevalence of nonobese participants with several metabolic risk factors was quite high and their CVD risk was high, excluding them from the diagnosis of metabolic syndrome because of the absence of obesity might overlook their risk.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 15 March 2007. DOI: 10.2337/dc06-2074.

    Members of the NIPPON DATA Research Group can be found in an online appendix at http://dx.doi.org/10.2337/dc06-2074.

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

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted March 6, 2007.
    • Received October 19, 2006.
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  1. Published online before print March 15, 2007, doi: 10.2337/dc06-2074 Diabetes Care June 2007 vol. 30 no. 6 1533-1538
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