Prognostic Impact of Metabolic Syndrome by Different Definitions in a Population With High Prevalence of Obesity and Diabetes
The Strong Heart Study
- Giovanni de Simone, MD12,
- Richard B. Devereux, MD1,
- Marcello Chinali, MD2,
- Lyle G. Best, MD3,
- Elisa T. Lee, PHD4,
- James M. Galloway, MD, MPH5,
- Helaine E. Resnick, PHD6 and
- for the Strong Heart Study Investigators
- 1Division of Cardiology, Weill Medical College of Cornell University, New York, New York
- 2Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
- 3Missouri Breaks Industries Research, Timber Lake, South Dakota
- 4Center for American Indian Health Research, University of Oklahoma, Oklahoma City, Oklahoma
- 5Indian Health Service, University of Arizona, Tucson, Arizona
- 6Medstar Research Institute, Washington, DC
- Address correspondence and reprint requests to Giovanni de Simone, MD, Department of Clinical and Experimental Medicine, Federico II University Hospital, v.S.Pansini 5, 80131 Naples, Italy. E-mail: simogi{at}unina.it
Abstract
OBJECTIVE— This study analyzed which definition of the metabolic syndrome is more predictive of cardiovascular events in both diabetic and nondiabetic members of a population-based sample.
RESEARCH DESIGN AND METHODS— A 10-year, longitudinal follow-up of the Strong Heart Study cohort has been evaluated. The analysis included 3,945 participants (2,384 female) with complete data (1,700 with diabetes and 1,468 with arterial hypertension) for evaluation of metabolic syndrome. Those with prevalent cardiovascular disease were excluded (n = 287, of whom 127 were female). Prevalence of metabolic syndrome was assessed based on the World Health Organization (WHO), the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III, and International Diabetes Federation (IDF) definitions. The main outcome was 10-year incidence of combined fatal and nonfatal cardiovascular events, including stroke, coronary heart disease, and congestive heart failure.
RESULTS— Fatal and nonfatal cardiovascular events occurred in 1,120 participants. After adjusting for age, sex, and diabetes, metabolic syndrome by all definitions was significantly associated with higher incidence of cardiovascular events (all P < 0.0001). In nondiabetic individuals, incident cardiovascular event rates were about 30–40% higher in those with metabolic syndrome, without a significant difference among definitions (0.03 < P < 0.001), and remained significant in WHO and NCEP ATP III definitions even after further adjustment for obesity, hypertension, and low HDL cholesterol. In the diabetic group, metabolic syndrome risk for cardiovascular events was greatest using the WHO definition (P < 0.002 vs. other models).
CONCLUSIONS— In individuals without diabetes, metabolic syndrome is associated with incident cardiovascular disease, especially with WHO and NCEP ATP III definitions. Metabolic syndrome also predicts higher cardiovascular event rates in diabetic participants, a prediction that is greatest using the WHO definition.
- HOMA, homeostasis model assessment
- IDF, International Diabetes Federation
- NCEP ATP, National Cholesterol Education Program Adult Treatment Panel
- SHS, Strong Heart Study
- WHO, World Health Organization
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 17 April 2007. DOI: 10.2337/dc06-2152.
The views expressed in this paper are those of the authors and do not necessarily reflect those of the Indian Health Service.
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.
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- Accepted March 30, 2007.
- Received October 18, 2006.
- DIABETES CARE
