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Prevalence of the metabolic syndrome and associated factors among inpatients with severe mental illness in Botswana: a cross-sectional study. BMC Cardiovasc Disord 2022; 22:515. [PMID: 36460970 PMCID: PMC9717503 DOI: 10.1186/s12872-022-02939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The metabolic syndrome, a cluster of inter-related risk factors for cardiovascular diseases is highly prevalent among individuals with obesity and sedentary lifestyle. Chronic psychiatric disorders such as severe mental illness are associated with increased risk for cardiovascular diseases. We aimed to assess the prevalence and correlates of metabolic syndrome among inpatients with severe mental illness in a resource limited setting with high HIV prevalence. METHODS This was a cross-sectional study among adult inpatients at a referral psychiatric hospital in Botswana. We used convenience sampling to enrol participants available at the time of the study. The National Cholesterol Education Program Adult Treatment Panel-III (NCEP-ATP III) criteria was used to define the metabolic syndrome. Data were analysed using descriptive statistics as well as multiple logistic regression modelling. RESULTS A total of 137 participants were enrolled. Of these, 119 (87%) had complete data for the main analysis. The overall prevalence of metabolic syndrome was 22.6% (95% CI 15.9, 30.6) and did not differ significantly by gender or HIV status. Age was significantly associated with the risk of having the metabolic syndrome while gender, body mass index, HIV status, and days of moderate physical activity were not. CONCLUSION There was a moderately high prevalence of metabolic syndrome. Thus, the management of individuals with severe mental illness in resource limited settings should include assessment of cardiovascular risk and target modifiable risk factors in this population. Consideration for the patient's age should be made when rationalizing the limited resources available for assessing metabolic syndrome among patients with severe mental illness.
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Ortega Y, Aragonès E, Piñol JL, Basora J, Araujo A, Cabré JJ. Impact of depression and/or anxiety on the presentation of cardiovascular events in a cohort with metabolic syndrome. StreX project: Five years of follow-up. Prim Care Diabetes 2018; 12:163-171. [PMID: 28988658 DOI: 10.1016/j.pcd.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 07/20/2017] [Accepted: 09/08/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the role of anxiety and depression on the incidence of cardiovascular events (CVE) in a Catalonian population with metabolic syndrome (MetS) over a five-year follow-up according to the number/type of MetS criteria. METHODS Prospective study to determine the incidence of CVE according to the presence of anxiety and depression disorders among individuals with different combinations of clinical traits of the MetS. SETTING Primary Care, Catalonia (Spain). SUBJECTS 35-75 years old fulfilling MetS criteria without CVE at the initiation of follow-up (2009). We studied 16 MetS phenotypes [NCEP-ATPIII criteria] based on the presence of depression/anxiety. The primary endpoint was the incidence of CVE at five years. RESULTS We analyzed 401,743 people with MetS (17.2% of the population); 8.7% had depression, 16.0% anxiety and 3.8% both. 14.5% consumed antidepressants and 20.8% tranquilizers. At the 5-year follow-up, the incidence of CVE was 5.5%, being 6.4% in men and 4.4% in women. On comparing individuals with and without depression the incidence of CVE was 6.7% vs. 5.3%, respectively (p<0.01), being 5.5% in both groups in relation to anxiety. CONCLUSION Depression and anxiety play a role in the poor prognosis of patients with MetS. In Catalonia, the two predominant MetS phenotypes do not include obesity as a criterion.
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Affiliation(s)
- Yolanda Ortega
- Basic Health Center Salou, Catalan Health Institute, Spain; IDIAP Jordi Gol, Catalan Health Institute, Spain
| | - Enric Aragonès
- IDIAP Jordi Gol, Catalan Health Institute, Spain; Primary Health Center Constantí, Catalan Health Institute, Spain
| | - Josep L Piñol
- IDIAP Jordi Gol, Catalan Health Institute, Spain; Primary Health Centre L'Ampolla, Catalan Health Institute, Spain; IISPV Pere Virgili, Rovira i Virgili University, Reus, Spain
| | - Josep Basora
- IDIAP Jordi Gol, Catalan Health Institute, Spain; IISPV Pere Virgili, Rovira i Virgili University, Reus, Spain
| | - Alvaro Araujo
- Basic Health Center Salou, Catalan Health Institute, Spain
| | - Juan J Cabré
- IDIAP Jordi Gol, Catalan Health Institute, Spain; Basic Health Center Sant Pere Centre, Catalan Health Institute, Spain; IISPV Pere Virgili, Rovira i Virgili University, Reus, Spain.
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Pirkle CM, Wu YY, Zunzunegui MV, Gómez JF. Model-based recursive partitioning to identify risk clusters for metabolic syndrome and its components: findings from the International Mobility in Aging Study. BMJ Open 2018; 8:e018680. [PMID: 29500203 PMCID: PMC5855443 DOI: 10.1136/bmjopen-2017-018680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Conceptual models underpinning much epidemiological research on ageing acknowledge that environmental, social and biological systems interact to influence health outcomes. Recursive partitioning is a data-driven approach that allows for concurrent exploration of distinct mixtures, or clusters, of individuals that have a particular outcome. Our aim is to use recursive partitioning to examine risk clusters for metabolic syndrome (MetS) and its components, in order to identify vulnerable populations. STUDY DESIGN Cross-sectional analysis of baseline data from a prospective longitudinal cohort called the International Mobility in Aging Study (IMIAS). SETTING IMIAS includes sites from three middle-income countries-Tirana (Albania), Natal (Brazil) and Manizales (Colombia)-and two from Canada-Kingston (Ontario) and Saint-Hyacinthe (Quebec). PARTICIPANTS Community-dwelling male and female adults, aged 64-75 years (n=2002). PRIMARY AND SECONDARY OUTCOME MEASURES We apply recursive partitioning to investigate social and behavioural risk factors for MetS and its components. Model-based recursive partitioning (MOB) was used to cluster participants into age-adjusted risk groups based on variabilities in: study site, sex, education, living arrangements, childhood adversities, adult occupation, current employment status, income, perceived income sufficiency, smoking status and weekly minutes of physical activity. RESULTS 43% of participants had MetS. Using MOB, the primary partitioning variable was participant sex. Among women from middle-incomes sites, the predicted proportion with MetS ranged from 58% to 68%. Canadian women with limited physical activity had elevated predicted proportions of MetS (49%, 95% CI 39% to 58%). Among men, MetS ranged from 26% to 41% depending on childhood social adversity and education. Clustering for MetS components differed from the syndrome and across components. Study site was a primary partitioning variable for all components except HDL cholesterol. Sex was important for most components. CONCLUSION MOB is a promising technique for identifying disease risk clusters (eg, vulnerable populations) in modestly sized samples.
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Affiliation(s)
- Catherine M Pirkle
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Yan Yan Wu
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | | | - José Fernando Gómez
- Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, Colombia
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Kim JA, Kim JY, Kang SW. Effects of the Dietary Detoxification Program on Serum γ-glutamyltransferase, Anthropometric Data and Metabolic Biomarkers in Adults. J Lifestyle Med 2016; 6:49-57. [PMID: 27924283 PMCID: PMC5115202 DOI: 10.15280/jlm.2016.6.2.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/09/2016] [Indexed: 11/22/2022] Open
Abstract
Background Persistent Organic Pollutants (POPs) are well-known environmental contaminants which are associated with chronic diseases. As foods are the major sources of human exposure to toxic pollutants, we developed an integrated dietary and education program to eliminate the chemical toxin throughout the human body. The present study evaluated effects of the dietary detoxification program on serum γ-glutamyltransferase (GGT), anthropometric data and metabolic biomarkers in adults. Methods Single-armed, pre-post study was conducted from June 2013 to June 2015 at a health examination center and a public health center in Seoul, Korea. Sixty eight subjects (mean age of 52.4 years) were recruited. Subjects participated 20 hours’ dietary education sessions. On-line coaching with SNS was performed to enhance participants’ proper protocol compliance. Physical and laboratory examinations were assessed at week 0 and 3. Results Changes of the serum GGT were correlated with reductions of the body fat percentage (r = .379, p = .001), body fat mass (r = .435, p = .000) and fasting blood glucose (r = .423, p = .000). Serum GGT, weight, body fat percentage, body fat mass, waist circumference, LDL-cholesterol, HDL-cholesterol, triglyceride, total cholesterol, and blood pressure of all participants were reduced with statistical significance in 3 weeks. In metabolic syndrome group, total cholesterol (p = .049), fasting blood glucose (p = .002), and systolic blood pressure (p = .001) were significantly reduced comparison to non-metabolic syndrome group. Conclusion This dietary detoxification program might decrease serum GGT which indicated the overall toxic burden in the body. Anthropometric data and metabolic biomarkers were improved. The integrated dietary and education detoxification program seemed to be a protective intervention for elimination of toxicants from the body.
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Affiliation(s)
- Ju Ah Kim
- College of Nursing, Seoul National University, Seoul, Korea
| | - Jin Young Kim
- Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Seung Wan Kang
- College of Nursing, Seoul National University, Seoul, Korea; Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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Weng L, Gong Y, Culver J, Gardell SJ, Petucci C, Morse AM, Frye RF, Turner ST, Chapman A, Boerwinkle E, Gums J, Beitelshees AL, Borum PR, Johnson JA, Garrett TJ, McIntyre LM, Cooper-DeHoff RM. Presence of arachidonoyl-carnitine is associated with adverse cardiometabolic responses in hypertensive patients treated with atenolol. Metabolomics 2016; 12:160. [PMID: 28217401 PMCID: PMC5313050 DOI: 10.1007/s11306-016-1098-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Atenolol, a commonly prescribed β blocker for hypertension, is also associated with adverse cardiometabolic effects such as hyperglycemia and dyslipidemia. Knowledge of the mechanistic underpinnings of these adverse effects of atenolol is incomplete. OBJECTIVE We sought to identify biomarkers associated with risk for these untoward effects of atenolol. We measured baseline blood serum levels of acylcarnitines (ACs) that are involved in a host of different metabolic pathways, to establish associations with adverse cardiometabolic responses after atenolol treatment. METHODS Serum samples from Caucasian hypertensive patients (n = 224) who were treated with atenolol in the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) study were interrogated using a quantitative LC/MS assay for a large number of unique ACs in serum. For the 23 ACs that were detected in serum from ≥80 % of all patients, we conducted linear regression for changes in cardiometabolic factors with baseline AC levels, baseline cardiometabolic factors, age, sex, and BMI as covariates. For the 5 ACs that were detected in serum from 20 to 79 % of the patients, we similarly modeled changes in cardiometabolic factors, but with specifying the AC as present/absent in the regression. RESULTS Among the 28 ACs, the presence (vs. absence) of arachidonoyl-carnitine (C20:4) was significantly associated with increased glucose (p = 0.0002), and was nominally associated with decreased plasma HDL-C (p = 0.017) and with less blood pressure (BP) lowering (p = 0.006 for systolic BP, p = 0.002 for diastolic BP), after adjustment. CONCLUSION Serum level of C20:4 is a promising biomarker to predict adverse cardiometabolic responses including glucose and poor antihypertensive response to atenolol.
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Affiliation(s)
- Liming Weng
- Department of Pharmacotherapy and Translational Research and Division of Cardiovascular Medicine, Colleges of Pharmacy and Medicine, Center for Pharmacogenomics, University of Florida, P.O. Box 100486, Gainesville, FL 32610-0486, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research and Division of Cardiovascular Medicine, Colleges of Pharmacy and Medicine, Center for Pharmacogenomics, University of Florida, P.O. Box 100486, Gainesville, FL 32610-0486, USA
| | - Jeffrey Culver
- Metabolomics Core, Sanford Burnham Prebys Medical Discovery Institute, Orlando, FL, USA; Southeast Center for Integrated Metabolomics (SECIM), University of Florida, Gainesville, FL, USA
| | - Stephen J Gardell
- Metabolomics Core, Sanford Burnham Prebys Medical Discovery Institute, Orlando, FL, USA; Southeast Center for Integrated Metabolomics (SECIM), University of Florida, Gainesville, FL, USA
| | - Christopher Petucci
- Metabolomics Core, Sanford Burnham Prebys Medical Discovery Institute, Orlando, FL, USA; Southeast Center for Integrated Metabolomics (SECIM), University of Florida, Gainesville, FL, USA
| | - Alison M Morse
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Reginald F Frye
- Department of Pharmacotherapy and Translational Research and Division of Cardiovascular Medicine, Colleges of Pharmacy and Medicine, Center for Pharmacogenomics, University of Florida, P.O. Box 100486, Gainesville, FL 32610-0486, USA
| | - Stephen T Turner
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Arlene Chapman
- Renal Division, School of Medicine, Emory University, Atlanta, GA, USA
| | - Eric Boerwinkle
- Human Genetics and Institute of Molecular Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - John Gums
- Department of Pharmacotherapy and Translational Research and Division of Cardiovascular Medicine, Colleges of Pharmacy and Medicine, Center for Pharmacogenomics, University of Florida, P.O. Box 100486, Gainesville, FL 32610-0486, USA
| | - Amber L Beitelshees
- Department of Medicine and Program in Personalized and Genomic Medicine, University of Maryland, Baltimore, MD, USA
| | - Peggy R Borum
- Department of Food Science and Human Nutrition, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, USA
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research and Division of Cardiovascular Medicine, Colleges of Pharmacy and Medicine, Center for Pharmacogenomics, University of Florida, P.O. Box 100486, Gainesville, FL 32610-0486, USA
| | - Timothy J Garrett
- Southeast Center for Integrated Metabolomics (SECIM), University of Florida, Gainesville, FL, USA; Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lauren M McIntyre
- Southeast Center for Integrated Metabolomics (SECIM), University of Florida, Gainesville, FL, USA; Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Division of Cardiovascular Medicine, Colleges of Pharmacy and Medicine, Center for Pharmacogenomics, University of Florida, P.O. Box 100486, Gainesville, FL 32610-0486, USA
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Sperling LS, Mechanick JI, Neeland IJ, Herrick CJ, Després JP, Ndumele CE, Vijayaraghavan K, Handelsman Y, Puckrein GA, Araneta MRG, Blum QK, Collins KK, Cook S, Dhurandhar NV, Dixon DL, Egan BM, Ferdinand DP, Herman LM, Hessen SE, Jacobson TA, Pate RR, Ratner RE, Brinton EA, Forker AD, Ritzenthaler LL, Grundy SM. The CardioMetabolic Health Alliance: Working Toward a New Care Model for the Metabolic Syndrome. J Am Coll Cardiol 2015; 66:1050-67. [PMID: 26314534 DOI: 10.1016/j.jacc.2015.06.1328] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 12/17/2022]
Abstract
The Cardiometabolic Think Tank was convened on June 20, 2014, in Washington, DC, as a "call to action" activity focused on defining new patient care models and approaches to address contemporary issues of cardiometabolic risk and disease. Individual experts representing >20 professional organizations participated in this roundtable discussion. The Think Tank consensus was that the metabolic syndrome (MetS) is a complex pathophysiological state comprised of a cluster of clinically measured and typically unmeasured risk factors, is progressive in its course, and is associated with serious and extensive comorbidity, but tends to be clinically under-recognized. The ideal patient care model for MetS must accurately identify those at risk before MetS develops and must recognize subtypes and stages of MetS to more effectively direct prevention and therapies. This new MetS care model introduces both affirmed and emerging concepts that will require consensus development, validation, and optimization in the future.
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Affiliation(s)
- Laurence S Sperling
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ian J Neeland
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cynthia J Herrick
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri
| | | | - Chiadi E Ndumele
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Maria Rosario G Araneta
- Department of Family and Preventive Medicine, University of California-San Diego, San Diego, California
| | - Quie K Blum
- Inova Heart and Vascular Institute, Fairfax, Virginia
| | | | - Stephen Cook
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Chicago, Illinois, and Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
| | | | - Dave L Dixon
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | - Brent M Egan
- Department of Medicine, University of South Carolina School of Medicine, Greenville, South Carolina
| | - Daphne P Ferdinand
- Healthy Heart Community Prevention Project, Inc., New Orleans, Louisiana
| | - Lawrence M Herman
- Department of Physician Assistant Studies, New York Institute of Technology, Old Westbury, New York
| | - Scott E Hessen
- Cardiology Consultants of Philadelphia and Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Terry A Jacobson
- Office of Health Promotion and Disease Prevention, Emory University School of Medicine, Atlanta, Georgia
| | - Russell R Pate
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | | | - Eliot A Brinton
- Utah Foundation for Biomedical Research and Utah Lipid Center, Salt Lake City, Utah
| | - Alan D Forker
- Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | - Scott M Grundy
- Department of Clinical Nutrition, University of Texas Southwestern Medical Center, Dallas, Texas
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The concomitant use of second-generation antipsychotics and long-term antiretroviral therapy may be associated with increased cardiovascular risk. Psychiatry Res 2014; 218:201-8. [PMID: 24794030 PMCID: PMC4082695 DOI: 10.1016/j.psychres.2014.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 04/03/2014] [Accepted: 04/07/2014] [Indexed: 02/06/2023]
Abstract
To study the effect of concurrent use of second-generation antipsychotics (SGAs) on metabolic syndrome (MetS) components conferring increased cardiovascular risk in a sample of human immunodeficiency virus (HIV)-infected adults taking antiretroviral therapy (ART). A retrospective study of participants consecutively recruited at the UCSD HIV Neurobehavioral Research Program examined effects of combined ART and SGAs on body mass index (BMI), nonfasting serum lipids, diabetes mellitus (DM) incidence, and mean arterial pressure (MAP). Metabolic outcome variables and covariates were compared using t-tests, Chi-squared or Fisher's exact tests. Linear and logistic multivariable models explored metabolic outcomes for participants taking (SGA+) or not taking (SGA-) concomitant SGAs, after controlling for demographic and HIV disease- and ART-related covariates. Of 2229 HIV-infected participants, 12% (N=258) were treated with SGAs. In multivariable models adjusted for relevant covariates, the SGA+ group had significantly higher mean triglycerides, significantly higher odds of DM, significantly higher MAPs and marginally higher BMI. The use of SGAs in HIV-infected adults taking ART was independently associated with worse indicators of MetS and cardiovascular risk. Aggressive monitoring for the metabolic complications from concurrent SGA and ART is indicated in all patients receiving these medication combinations.
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Rutter MK, Meigs JB, Wilson PWF. Cardiovascular risk and the metabolic syndrome. Metab Syndr Relat Disord 2012; 4:252-60. [PMID: 18370744 DOI: 10.1089/met.2006.4.252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Clustering of metabolic syndrome (MetS) components within individuals helps in the identification of subjects who are at increased risk for both cardiovascular disease (CVD) and diabetes. In this review we describe how the presence of MetS influences CVD risk. Our review focuses on published studies through May 2006 referring to incident CVD in relation to the National Cholesterol Education Program Adult Treatment Panel III (NCEP) definition of the MetS. We present data suggesting that the Framingham risk function is the most appropriate method for assessing CVD risk in subjects with or without MetS. We show how the CVD risk associated with MetS is influenced by the inclusion of subjects with diabetes and CVD at baseline, and by the development of diabetes during follow-up, and that this might explain why MetS may be a stronger risk factor for CVD in women than in men. We present data suggesting that CVD risk associated with MetS does not appear to be greater than the sum of its parts, and that adding CRP to MetS variables does not improve population CVD risk prediction. Lifestyle intervention and treatment of specific abnormal MetS components are appropriate until a better understanding of the pathogenesis of MetS is available. At such time we may be able to target the underlying causes of the syndrome and ultimately prevent the development of both CVD and diabetes.
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Affiliation(s)
- Martin K Rutter
- Cardiovascular Research Group, Division of Cardiovascular and Endocrine Sciences, University of Manchester and Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester, UK
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Moebus S, Balijepalli C, Lösch C, Göres L, von Stritzky B, Bramlage P, Wasem J, Jöckel KH. Age- and sex-specific prevalence and ten-year risk for cardiovascular disease of all 16 risk factor combinations of the metabolic syndrome - A cross-sectional study. Cardiovasc Diabetol 2010; 9:34. [PMID: 20696055 PMCID: PMC2929217 DOI: 10.1186/1475-2840-9-34] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Accepted: 08/09/2010] [Indexed: 01/26/2023] Open
Abstract
Background Based on the AHA/NHLBI-definition three out of five cardiometabolic traits must be present for the diagnosis of the metabolic syndrome (MetS), resulting in 16 different combination types. The associated cardiovascular risk may however be different and specific combination may be indicative of an increased risk, furthermore little is known to which extent these 16 combinations contribute to the overall prevalence of MetS. Here we assessed the prevalence of all 16 combination types of MetS, analyzed the impact of age and gender on prevalence rates, and estimated the 10-year risk of fatal and non-fatal myocardial infarction (MI) of each MetS combination type. Methods We used data of the German Metabolic and Cardiovascular Risk Project (GEMCAS), a cross-sectional study, performed during October 2005, including 35,869 participants (aged 18-99 years, 61% women). Age-standardized prevalence and 10-year PROCAM and ESC risk scores for MI were calculated. Results In both men and women the combination with elevated waist-circumference, blood pressure and glucose (WC-BP-GL) was the most frequent combination (28%), however a distinct unequal distribution was observed regarding age and sex. Any combination with GL was common in the elderly, whereas any combination with dyslipidemia and without GL was frequent in the younger. Men without MetS had an estimated mean 10-year risk of 4.7% (95%-CI: 4.5%-4.8%) for MI (PROCAM), whereas the mean 10-year risk of men with MetS was clearly higher (age-standardized 7.9%; 7.8-8.0%). In women without MetS the mean 10-year risk for MI was 1.1%, in those with MetS 2.3%. The highest impact on an estimated 10-year risk for MI (PROCAM) was observed with TG-HDL-GL-BP in both sexes (men 14.7%, women 3.9%). However, we could identify combinations with equal risks of non-fatal and fatal MI compared to participants without MetS. Conclusions We observed large variations in the prevalence of all 16 combination types and their association to cardiovascular risk. The importance of different combinations of MetS changes with age and between genders putting emphasis on a tailored approach towards very young or very old subjects. This knowledge may guide clinicians to effectively screen individuals and prioritize diagnostic procedures depending on age and gender.
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Affiliation(s)
- Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Germany.
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Abstract
Schizophrenia patients have high prevalence of cardiovascular (CV) disease risk factors and high CV mortality, with increasing concern over the contribution of antipsychotic medications to cardiometabolic risk. The design of the NIMH-sponsored Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial was driven by a need to understand the efficacy and safety differences between atypical antipsychotics, and between atypical and typical antipsychotics. The CATIE data indicated differences between olanzapine and other antipsychotics in phase 1 on the primary outcome measure, time to drug discontinuation, yet olanzapine was not superior to risperidone in the phase 2 tolerability arm, and was inferior to clozapine in the phase 2 efficacy arm. However, CATIE provided clear confirmation of the metabolic liability for olanzapine and also quetiapine, particularly on measures associated with insulin resistance: fasting triglycerides and central adiposity. Current research is focused on analyzing the adiposity-independent impact of certain antipsychotics on glucose-insulin homeostasis, and the disease-specific biological factors that predispose schizophrenia patients to metabolic dysfunction. The CATIE data also highlighte the high prevalence of metabolic disorders in chronic schizophrenia patients, and the moderating role of gender and race or ethnicity in antipsychotic-associate metabolic adverse effects. In the post-CATIE era, safety concerns remain the primary driver of antipsychotic prescribing habits. Absent compelling efficacy data that differentiates between antipsychotics for nonrefractory schizophrenia, the CATIE results reinforce the need for additional metabolically neutral antipsy chotic treatment options, and the importance of ongoing physical health monitorin for schizophrenia patients.
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Affiliation(s)
- Jonathan M Meyer
- Department of Psychiatry, University of California, La Jolla, CA 92093, USA.
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Ferrario CM, Moore MA, Bestermann W, Colby C, Exuzides A, Simmons D, Panjabi S. COSEHC global vascular risk management quality improvement program: rationale and design. Vasc Health Risk Manag 2010; 6:1135-45. [PMID: 21931496 PMCID: PMC3169675 DOI: 10.2147/vhrm.s13746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Indexed: 12/04/2022] Open
Abstract
Background: The Consortium for Southeastern Hypertension Control (COSEHC) promotes global risk factor management in patients with metabolic syndrome. The COSEHC Global Vascular Risk Management Study (GVRM) intends to quantify these efforts on long-term patient outcomes. The objectives of this study were to present baseline demographics of patients enrolled in the GVRM, calculate a modified COSEHC risk score using 11 variables (COSEHC-11), and compare it with the original COSEHC-17 and Framingham, Prospective Cardiovascular Münster (PROCAM), and Systemic Coronary Risk Evaluation (SCORE) risk scores. Methods: Deidentified electronic medical records of enrolled patients were used to calculate the risk scores. The ability of the COSEHC-11 score to predict the COSEHC-17 score was assessed by regression analysis. Raw risk scores were converted to probability estimates of fatal coronary heart disease (CHD) and compared with predicted risks from other algorithms. Results: Of the 177,404 patients enrolled, 43,676 had data for all 11 variables. The COSEHC-11 score (mean ± standard deviation) of these 43,676 patients was 31.75 ± 11.66, implying a five-year fatal CHD risk of 1.4%. The COSEHC-11 score was highly predictive of the COSEHC-17 score (R2 = 0.93; P < 0.0001) and correlated well with the SCORE algorithm. Conclusion: The COSEHC-11 risk score is statistically similar to the COSEHC-17 risk score and should be a viable tool for evaluating its ability to predict five-year cardiovascular mortality in the coming years.
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Affiliation(s)
- Carlos M Ferrario
- Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Shin CY, Yun KE, Park HS. Blood pressure has a greater impact on cardiovascular mortality than other components of metabolic syndrome in Koreans. Atherosclerosis 2009; 205:614-9. [PMID: 19232617 DOI: 10.1016/j.atherosclerosis.2009.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 12/26/2008] [Accepted: 01/11/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Limited information is currently available on the association of metabolic syndrome or individual components with risk of cardiovascular morbidity and mortality in diverse populations. Here, we investigate the relationship of metabolic syndrome and its individual components with cardiovascular mortality in Korean adults. METHODS Data were obtained from 57,237 patients (32,819 men and 24,418 women), aged 40-89 years, subjected to regular health examinations at the Health Promotion Center of Asan Medical Center, Seoul, Korea (1999-2001) and subsequently followed up for a median time of 5.6 years. The risk of cardiovascular mortality was analyzed in relation to metabolic syndrome and its individual components. RESULTS The risk of cardiovascular mortality attributable to elevated blood pressure was approximately 52% in men and 72% in women, respectively. Compared to subjects without metabolic syndrome, individuals with metabolic syndrome presented a relative risk (RR) of cardiovascular disease (CVD)-induced death of 1.75 (95% CI, 1.15-2.66). After mutual adjustment for the individual components of metabolic syndrome, elevated blood pressure was significantly associated with CVD death, with RR values of 2.08 (95% CI, 1.27-3.42) in men and 3.56 (95% CI, 1.55-8.19) in women. CONCLUSION In Koreans, metabolic syndrome increases the risk of CVD death, with the blood pressure component being the key predictor of mortality.
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Affiliation(s)
- Chan Yim Shin
- Department of Family Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
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14
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Tsai SP, Wen CP, Chan HT, Chiang PH, Tsai MK, Cheng TYD. The effects of pre-disease risk factors within metabolic syndrome on all-cause and cardiovascular disease mortality. Diabetes Res Clin Pract 2008; 82:148-56. [PMID: 18757109 DOI: 10.1016/j.diabres.2008.07.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 06/02/2008] [Accepted: 07/13/2008] [Indexed: 11/24/2022]
Abstract
The metabolic syndrome has been criticized for being "polluted with the inclusion of frank "diseases" with "pre-diseases". We assessed the effect of a single and a combination of "pre-disease" risk factors of metabolic syndrome on the overall and cardiovascular disease (CVD) mortality. These pre-disease risk factors included pre-diabetes, pre-hypertension, overweight and borderline hypertriglycerdemia and were defined as: fasting glucose at 110-125 mg/dL, systolic blood pressure at 120-139 mmHg, body mass index at 25-29.9 kg/m(2) and serum triglyceride at 150-199 mg/dL, respectively. The metabolic syndrome in this paper was based on the version defined by the ATP III. The cohort consisted of 35,259 adults (>==40 years) with a medium follow-up of 15 years. Relative risks (RRs) for all-causes, CVD and "CVD plus diabetes" mortality were calculated with the Cox proportional hazards model. Prevalence of the pre-disease risk factors (40.2%) was nearly four times larger than the metabolic syndrome (10.6%). Individual pre-disease risk factor was associated with significant increases of 13% and 67% (pre-diabetes), 22% and 62% (pre-hypertension), 23% and 32% (overweight) and 17% and 46% (borderline hypertriglyceridemia) on all-cause and "CVD plus diabetes" mortality, respectively. Smoking had comparable risks as "pre-diseases", and, as such, should also be considered as the fifth "pre-disease". Like metabolic syndrome, each "Pre-disease" is a major and significant risk factor for all cause and cardiovascular mortality, but unlike metabolic syndrome, the definition or clinical follow up of "Pre-disease" is simple and straightforward. Recognizing each of the four "pre-disease" as a clinical entity, a hitherto sub-clinical status but involving significantly increased mortality, can alert and justify early intervention through changing lifestyle and modifying biologic risk factors.
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Affiliation(s)
- Shan Pou Tsai
- University of Texas, School of Public Health, Houston, TX, USA
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Lopez-Alvarenga JC, Solís-Herrera C, Kent JW, Jaju D, Albarwani S, Al Yahyahee S, Hassan MO, Bayoumi R, Comuzzie AG. Prevalence and heritability of clusters for diagnostic components of metabolic syndrome: the Oman family study. Metab Syndr Relat Disord 2008; 6:129-35. [PMID: 18484902 DOI: 10.1089/met.2007.0039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prevalence and heritability of metabolic syndrome (MetS) vary between populations according to the currently used criteria. We examined combinations for joint probabilities and heritabilities of MetS criteria from the National Cholesterol Education Program Adult Treatment Panel III (NCEP), World Health Organization (WHO), and International Diabetes Federation (IDF) in a sample of Omani families. METHODS We included 1277 subjects from 5 pedigrees. The likelihood ratio of diagnostic cluster dependence over clustering by chance was LDep = P(dependent)/P(independent). Heritabilities were adjusted by sex and age. RESULTS The highest LDep were central obesity (CO) + high glucose level (HGl) + triglycerides (IDF, 3.08; NCEP, 4.38; WHO, 3.17; P < 0.001). Triglycerides combined with any other component were the most common cluster. The lowest LDep for IDF were high blood pressure (HBP) + CO + low HDL-C (1.21, P < 0.025); for NCEP were HBP + HGl + low HDL-C (1.21, P < 0.07). These components were gathered almost by chance alone. In contrast, the lowest LDep for WHO were HGl + CO + low HDL-C (2.01, P < 0.001). The WHO criteria yielded the highest heritability for a MetS diagnosis (h(2) = 0.9), followed by NCEP (0.48) and IDF (0.38). The rationale of the MetS diagnostics is based on insulin resistance. This base would be lost if we continue lowering cut-off points for diagnosis for increasing the sensitivity. The WHO showed the highest values for LDep for all components because they used the highest cut-off points.
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Affiliation(s)
- Juan C Lopez-Alvarenga
- Department of Genetics, Southwest Foundation for Biomedical Research, San Antonio, TX, USA.
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Meyer JM, Davis VG, Goff DC, McEvoy JP, Nasrallah HA, Davis SM, Rosenheck RA, Daumit GL, Hsiao J, Swartz MS, Stroup TS, Lieberman JA. Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE Schizophrenia Trial: prospective data from phase 1. Schizophr Res 2008; 101:273-86. [PMID: 18258416 PMCID: PMC3673564 DOI: 10.1016/j.schres.2007.12.487] [Citation(s) in RCA: 181] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Revised: 12/06/2007] [Accepted: 12/22/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The metabolic syndrome (MS) is associated with increased risk for diabetes mellitus and coronary heart disease, and is highly prevalent among schizophrenia patients. Given concerns over antipsychotic metabolic effects, this analysis explored MS status and outcomes in phase 1 of the CATIE Schizophrenia Trial. METHODS The change in proportion of subjects with MS and individual criteria was compared between antipsychotic treatment groups, along with mean changes for individual criteria. Primary analyses examined subjects with fasting laboratory assessments at baseline and 3 months. Other analyses examined 3-month changes in MS status, waist circumference (WC), HDL cholesterol and blood pressure in all subjects, metabolic changes at the end of phase 1 participation (EOP), and repeated measures changes in HDL, blood pressure (BP) and WC over phase 1. RESULTS At 3 months, there were no significant between-drug differences for the change in proportion of subjects meeting MS status or individual MS criteria in the smaller fasting cohort (n = 281) or for those meeting criteria for parameters not dependent on fasting status (BP, HDL, WC) among all subjects (n=660). Among all subjects whose MS status could be determined at 3 months (n=660), MS prevalence increased for olanzapine (from 34.8% to 43.9%), but decreased for ziprasidone (from 37.7% to 29.9%) (p=.001). Although effect sizes varied across subgroups, at 3 months olanzapine and quetiapine had the largest mean increase in waist circumference (0.7 in. for both) followed by risperidone (0.4 in.), compared to no change for ziprasidone (0.0 in.) and a decrease in waist circumference for perphenazine (-0.4 in.). Olanzapine also demonstrated significantly different changes in fasting triglycerides at 3 months (+21.5 mg/dl) compared to ziprasidone (-32.1 mg/dl). EOP exposure data was obtained, on average, nine months from baseline for all metabolic variables. Results from EOP and repeated measures analyses were consistent with those at 3 months for mean changes in WC and fasting triglycerides, but between group differences emerged for HDL and SBP. CONCLUSIONS This large non-industry sponsored study confirms the differential metabolic effects between antipsychotics. Clinicians are advised to monitor all metabolic parameters, including WC, HDL and serum triglycerides, during antipsychotic treatment.
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Affiliation(s)
- Jonathan M. Meyer
- Department of Psychiatry, University of California, San Diego
- VA San Diego Healthcare System,
| | - Vicki G. Davis
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Bank of America Center, 137 E. Franklin Street, Suite 400, Chapel Hill, NC 27514-4145,
| | - Donald C. Goff
- Department of Psychiatry, Harvard University
- Schizophrenia Program, Massachusetts General Hospital, Freedom Trail Clinic - Lindemann Mental Health Center, 25 Staniford St., Boston, MA 02114,
| | - Joseph P. McEvoy
- Department of Psychiatry and Behavioral Sciences, Duke University, Clinical Research, John Umstead Hospital, 1003 12 Street, Butner, NC 27509,
| | - Henry A. Nasrallah
- University of Cincinnati, 231 Albert Sabin Way, PO Box 670559, Cincinnati, OH 45267-0559, or
| | - Sonia M. Davis
- Quintiles Inc., 5927 South Miami Blvd, Morrisville, NC 27560,
| | - Robert A. Rosenheck
- Epidemiology and Public Health, and the Child Study Center, Yale Medical School
- Northeast Program Evaluation Center , VA Connecticut Health Care System, 950 Campbell Ave, West Haven, CT 06516,
| | - Gail L. Daumit
- Johns Hopkins Medical Institutions, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287,
| | - John Hsiao
- Adult Psychopharmacology Intervention Program, National Institute of Mental Health, Bethesda, MD,
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3173, Duke University Medical Center, Durham, NC 27710,
| | - T. Scott Stroup
- Department of Psychiatry, University of North Carolina at Chapel Hill, Campus Box 7160, Chapel Hill, NC 27599-7160,
| | - Jeffrey A. Lieberman
- Department of Psychiatry, Columbia University, Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032,
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Benyamin B, Sørensen TIA, Schousboe K, Fenger M, Visscher PM, Kyvik KO. Are there common genetic and environmental factors behind the endophenotypes associated with the metabolic syndrome? Diabetologia 2007; 50:1880-1888. [PMID: 17624514 DOI: 10.1007/s00125-007-0758-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 06/05/2007] [Indexed: 01/01/2023]
Abstract
AIMS/HYPOTHESIS The cluster of obesity, insulin resistance, dyslipidaemia and hypertension, called the metabolic syndrome, has been suggested as a risk factor for cardiovascular disease and type 2 diabetes. The aim of the present study was to evaluate whether there are common genetic and environmental factors influencing this cluster in a general population of twin pairs. MATERIALS AND METHODS A multivariate genetic analysis was performed on nine endophenotypes associated with the metabolic syndrome from 625 adult twin pairs of the GEMINAKAR study of the Danish Twin Registry. RESULTS All endophenotypes showed moderate to high heritability (0.31-0.69) and small common environmental variance (0.05-0.21). In general, genetic and phenotypic correlations between the endophenotypes were strong only within sets of physiologically similar endophenotypes, but weak to moderate for other pairs of endophenotypes. However, moderate correlations between insulin resistance indices and either obesity-related endophenotypes or triacylglycerol levels indicated that some common genetic backgrounds are shared between those components. CONCLUSIONS/INTERPRETATION We demonstrated that, in a general population, the endophenotypes associated with the metabolic syndrome apparently do not share a substantial common genetic or familial environmental background.
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Affiliation(s)
- B Benyamin
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, Scotland, UK
- Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - T I A Sørensen
- Danish Epidemiology Science Centre, Institute of Preventive Medicine, Copenhagen University Hospitals, Centre for Health and Society, Copenhagen, Denmark
| | - K Schousboe
- The Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, Sdr. Boulevard 23A, 5000, Odense C, Denmark
| | - M Fenger
- Department of Clinical Biochemistry, University Hospital of Copenhagen, Hvidovre, Denmark
| | - P M Visscher
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, Scotland, UK
- Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - K O Kyvik
- The Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, Sdr. Boulevard 23A, 5000, Odense C, Denmark.
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Lorenzo C, Serrano-Ríos M, Martínez-Larrad MT, González-Villalpando C, González-Sánchez JL, Martínez-Calatrava MJ, Gabriel R, Haffner SM. Is waist circumference an essential component of the metabolic syndrome? Diabetes Care 2007; 30:2141-2. [PMID: 17519434 DOI: 10.2337/dc06-2627] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Carlos Lorenzo
- Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78284-7873, USA.
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Hollman G, Kristenson M. The prevalence of the metabolic syndrome and its risk factors in a middle-aged Swedish population--mainly a function of overweight? Eur J Cardiovasc Nurs 2007; 7:21-6. [PMID: 17586094 DOI: 10.1016/j.ejcnurse.2007.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 05/17/2007] [Accepted: 05/21/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of obesity, one risk factor for developing the metabolic syndrome (MS), has increased during the last decades. It has therefore been assumed that the prevalence of MS would also increase. AIMS The aim was to analyse the prevalence of MS and its risk factors in a middle-aged Swedish population. METHODS Data were obtained between 2003 and 2004 from a random population based sample of 502 men and 505 women, 45-69 years old. Measures of plasma glucose, serum lipids, blood pressure, weight, height, waist circumference and self-reported data concerning presence of disease, medication and lifestyle were obtained. RESULTS The prevalence of MS was 14.8% among men and 15.3% among women, with an increase by age among women only, 10% to 25% (p=0.029). Among individuals with MS the most frequent risk factor was large waist circumference, present in 85% of men and 99% of women, followed by high blood pressure, high triglycerides, high glucose and HDL cholesterol (38% and 47% respectively). CONCLUSION The prevalence of MS was 15%, increasing with age only among women. Overweight was a dominant characteristic, and only half of the individuals with MS had glucose/HDL cholesterol levels beyond defined cut points of the syndrome.
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Affiliation(s)
- Gunilla Hollman
- Department of Medicine and Care, Division of Nursing Sciences, Faculty of Health Sciences, Linköping University, 581 85 Linköping, Sweden.
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20
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Ardern CI, Janssen I. Metabolic syndrome and its association with morbidity and mortality. Appl Physiol Nutr Metab 2007; 32:33-45. [PMID: 17332783 DOI: 10.1139/h06-099] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that are associated with increased risk of diabetes, cardiovascular disease (CVD), and all-cause mortality; however, it is clear that considerable variation exists in these relationships. Given that the prevalence of MetS increases with age, is higher in men than in women, and varies with race and ethnicity, a number of questions about the clinical application of MetS in predicting morbidity and mortality in diverse populations remain unanswered. Thus, in this review, we compare the ability of MetS to predict health risk across age, sex, race, and ethnicity, and in primary versus secondary prevention subgroups to explore these relationships. Furthermore, as there is currently no universal MetS criteria, we also discuss differences in the prediction of morbidity and mortality in studies that used different criteria to define MetS. At present, further research is necessary to examine the health risks associated with (i) different combinations of MetS components in diverse populations, (ii) the relative importance of each MetS component in predicting different health outcomes, and (iii) the independent contribution of MetS in predicting risk of morbidity and mortality beyond that incurred by other risk factors.
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Affiliation(s)
- Chris I Ardern
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
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21
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Nilsson PM, Engström G, Hedblad B. The metabolic syndrome and incidence of cardiovascular disease in non-diabetic subjects--a population-based study comparing three different definitions. Diabet Med 2007; 24:464-72. [PMID: 17381496 DOI: 10.1111/j.1464-5491.2007.02142.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Between 1998 and 2005, a number of definitions of the metabolic syndrome (MetS) have been proposed. The aim of this population-based cohort study was to compare prevalence rates and the prediction of cardiovascular disease (CVD) using different definitions of MetS. METHODS A total of 5047 non-diabetic subjects (66% women), from the city of Malmö, Sweden, were followed. The incidence of fatal and non-fatal CVD (cardiac events, n = 176, and stroke, n = 171) was monitored over 11 years of follow-up. MetS was defined in three different ways [by International Diabetes Federation (IDF), National Cholesterol Education Program--Adult Treatment Panel III (NCEP-ATPIII), or European Group for the study of Insulin Resistance (EGIR) criteria] based on data on waist circumference, blood pressure, serum triglycerides, High-density lipoprotein cholesterol and fasting blood glucose. The IDF definition identified 21.9% of the subjects having the MetS. Corresponding figures for the NCEP-ATPIII and EGIR definitions were 20.7 and 18.8%, respectively. RESULTS After taking age, gender, low-density lipoprotein cholesterol and lifestyle factors into account, the hazard ratio (HR) for CVD event according to the IDF, NCEP-ATPIII and EGIR definitions were HR 1.11 (95% CI: 0.86-1.44), 1.59 (1.25-2.03) and 1.35 (1.05-1.74), respectively. The results were largely similar for cardiac and stroke events. CONCLUSIONS The prevalence of Mets according to the IDF definition was higher in comparison with NCEP-ATPIII and EGIR definitions, but the IDF definition was not superior to these definitions for prediction of CVD events. This was true for both genders and questions the usefulness of the current IDF criteria of MetS in a North-European, Caucasian population. In addition, single risk factors such as smoking had an equal prediction as the metabolic syndrome.
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Affiliation(s)
- P M Nilsson
- Section of Medicine, Department of Clinical Sciences Medicine, University Hospital, Malmö, Sweden.
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22
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Chien KL, Lee BC, Hsu HC, Lin HJ, Chen MF, Lee YT. Prevalence, agreement and classification of various metabolic syndrome criteria among ethnic Chinese: a report on the hospital-based health diagnosis of the adult population. Atherosclerosis 2007; 196:764-71. [PMID: 17291512 DOI: 10.1016/j.atherosclerosis.2007.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 12/19/2006] [Accepted: 01/09/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Many criteria of metabolic syndrome have been made available to practitioners in the recent past. This study has been designed to investigate the distribution, agreement and classification patterns of these criteria among the ethnic Chinese population. METHODS A total of 6610 (women, 42.5%) adults (mean, 52.3 years) were recruited from the hospital-based health diagnosis program during 2004. We divided criteria of metabolic syndrome into two groups: those with a major component required (WHO, EGIR, AACE, IDF) and those with equal component (ATP III, AHA, with modifications). RESULTS The highest standardized rates were in Asian AHA criterion, up to 29.8% in men and 25.6% in women. The lowest rates were in WHO criterion, 8.8% in men and 8.0% in women. The kappa values using all criteria were 0.59 in men and 0.65 in women and decreased in the major component group (0.50 in men, 0.54 in women), while increased in the equal component group (0.83 in men, 0.81 in women). Using hierarchical cluster analysis and dendrograms, two large clusters were identified in men (major components and equal components); however, mixed sub-clusters of major and equal components apparently grouped by insulin resistance and obesity criteria in women. CONCLUSIONS There is substantial agreement and grouping of metabolic syndrome models among ethnic Chinese.
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Affiliation(s)
- Kuo-Liong Chien
- Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taiwan.
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23
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Ardern CI, Katzmarzyk PT. Geographic and Demographic Variation in the Prevalence of the Metabolic Syndrome in Canada. Can J Diabetes 2007. [DOI: 10.1016/s1499-2671(07)11009-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Roberts DCK. Metabolic syndrome: an outmoded concept? Curr Opin Lipidol 2006; 17:192-4. [PMID: 16531757 DOI: 10.1097/01.mol.0000217902.05563.5f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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