Prognostic Impact of Metabolic Syndrome by Different Definitions in a Population with High Prevalence of Obesity and Diabetes: The Strong Heart Study.

Abstract

Objective: This study analyzed which definition of the metabolic syndrome (MetS) is more predictive of cardiovascular events in both diabetic and non-diabetic members of a population based sample.

Research Design and Method: Ten-year longitudinal follow-up of the Strong Heart Study cohort has been evaluated. The analysis included 3,945 participants (2,384 women) with complete data (1,700 with diabetes; 1,468 with arterial hypertension) for evaluation of MetS. Those with prevalent cardiovascular disease were excluded (n=287, 127 women). Prevalence of MetS was assessed based on WHO, ATPIII, and IDF definitions. Main outcome was 10-year incidence of combined fatal and non fatal cardiovascular events (CVe), including stroke, coronary heart disease and congestive heart failure.

Results: Fatal and non-fatal CVe occurred in 1,120 participants. After adjusting for age, sex and diabetes, MetS by all definitions was significantly associated with higher incidence of CVe, (all p<0.0001). In nondiabetic individuals, incident CVe rates were about 30-40% higher in those with MetS, without significant difference among definitions (0.03<p<0.001), and remained significant in WHO and ATPIII definitions even after further adjustment for obesity, hypertension, and low HDL-cholesterol. In the diabetic group, MetS risk for CVe was greatest using the WHO definition (p<0.002 vs other models).

Conclusions: In persons without diabetes, MetS is associated with incident cardiovascular disease, especially with WHO and ATPIII definitions. MetS also predicts higher CV event rates in diabetic participants, a prediction that is greatest using the WHO definition.