Abstract

Objective: To compare the predictive value for coronary heart disease (CHD) of the International Diabetes Federation (IDF) definition (with Asian criteria for central obesity) of the metabolic syndrome (MES) to existing criteria of the National Cholesterol Education Program's Adult Treatment Panel III (NCEP) in Chinese subjects with type 2 diabetes.

Research Design and Methods: Subjects with type 2 diabetes and without macrovascular diseases or end-stage renal disease were categorized by the criteria of IDF and NCEP. CHD was defined as myocardial infarction, ischemic heart disease, coronary revascularization, heart failure and death related to CHD.

Results: Of 4350 patients (age: 54.4 ± 13.4 years, median follow-up period: 7.1 [interquartile range: 5.2 - 8.5] years), 65.9% had MES according to either IDF or NCEP criteria. NCEP definition identified MES in 786 subjects (NCEP-only: 18.1%) who did not fulfill the criteria of IDF. HDL-Cholesterol and systolic blood pressure were predictors of CHD after adjustment for other confounding factors. Compared to subjects without MES, IDF criteria failed to predict CHD (hazard ratio [95% CI, p]: 1.13 [0.86 - 1.48], p=0.374). In contrast, NCEP definition (2.51 [1.80 - 3.50], p<0.001]) predicted increased risk of CHD with the NCEP-only group having the highest risk (2.49 [1.66 - 3.73], p<0.001).

Conclusions: With established type 2 diabetes, the IDF definition of MES failed to identify a subgroup of patients who were at highest risk for CHD. Practitioners must recognize the appropriate setting for its application.