An exploratory analysis of criteria for the metabolic syndrome and its prediction of long-term cardiovascular outcomes: the Hoorn study

Prevalence of the metabolic syndrome and associated factors among inpatients with severe mental illness in Botswana: a cross-sectional study

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.

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

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.

Model-based recursive partitioning to identify risk clusters for metabolic syndrome and its components: findings from the International Mobility in Aging Study

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.

Effects of the Dietary Detoxification Program on Serum γ-glutamyltransferase, Anthropometric Data and Metabolic Biomarkers in Adults

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.

Presence of arachidonoyl-carnitine is associated with adverse cardiometabolic responses in hypertensive patients treated with atenolol

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.

The CardioMetabolic Health Alliance: Working Toward a New Care Model for the Metabolic Syndrome

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.

The concomitant use of second-generation antipsychotics and long-term antiretroviral therapy may be associated with increased cardiovascular risk

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.

Cardiovascular risk and the metabolic syndrome

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.

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

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.

Antipsychotics and metabolics in the post-CATIE era

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.

COSEHC global vascular risk management quality improvement program: rationale and design

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.

Blood pressure has a greater impact on cardiovascular mortality than other components of metabolic syndrome in Koreans

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.

The effects of pre-disease risk factors within metabolic syndrome on all-cause and cardiovascular disease mortality

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.

Prevalence and heritability of clusters for diagnostic components of metabolic syndrome: the Oman family study

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.

Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE Schizophrenia Trial: prospective data from phase 1

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.

Are there common genetic and environmental factors behind the endophenotypes associated with the metabolic syndrome?

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.

The prevalence of the metabolic syndrome and its risk factors in a middle-aged Swedish population--mainly a function of overweight?

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.

Metabolic syndrome and its association with morbidity and mortality

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.

The metabolic syndrome and incidence of cardiovascular disease in non-diabetic subjects--a population-based study comparing three different definitions

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.

Prevalence, agreement and classification of various metabolic syndrome criteria among ethnic Chinese: a report on the hospital-based health diagnosis of the adult population

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.