Adult Treatment Panel III 2001 but Not International Diabetes Federation 2005 Criteria of the Metabolic Syndrome Predict Clinical Cardiovascular Events in Subjects Who Underwent Coronary Angiography

Abstract

OBJECTIVE -The International Diabetes Federation (IDF) has recently established a worldwide consensus definition of the metabolic syndrome. No prospective data are available on the cardiovascular risk associated with this new metabolic syndrome definition. RESEARCH DESIGN AND METHODS-In a prospective study of 750 coronary patients, we recorded vascular events over 4 years.RESULTS -From our patients, 37.3% (n ϭ 280) had the metabolic syndrome according to the Adult Treatment Panel III (ATPIII) definition and 45.5% (n ϭ 341) according to the IDF definition. The metabolic syndrome as defined by the ATPIII criteria significantly predicted vascular events (adjusted hazard ratio 1.745 [95% CI 1.255-2.427]; P ϭ 0.001), but the metabolic syndrome as defined by IDF criteria did not (1.189 [0.859 -1.646]; P ϭ 0.297). Accordingly, event-free survival was significantly lower among patients who fulfilled the ATPIII but not the IDF criteria than among those who met the IDF but not the ATPIII criteria (P ϭ 0.012). The metabolic syndrome as defined by ATPIII criteria remained significantly predictive of vascular events after adjustment for type 2 diabetes but not after additional adjustment for the metabolic syndrome components high triglycerides and low HDL cholesterol. These lipid traits in turn proved significantly predictive of vascular events even after adjustment for the metabolic syndrome.CONCLUSIONS -The ATPIII definition of the metabolic syndrome confers a significantly higher risk of vascular events than the IDF definition. However, among angiographied coronary patients, even the ATPIII definition of the metabolic syndrome does not provide prognostic information beyond its dyslipidemic features. Diabetes Care 29:901-907, 2006T he term metabolic syndrome refers to a cluster of cardiovascular risk factors associated with insulin resistance (1,2). During the past decade, there have been various attempts to standardize the definition of the metabolic syndrome as a diagnostic category, with several institutions proposing various criteria (3-7).The definition of the metabolic syndrome that has most often been used in the literature was proposed by the National Cholesterol Education Program's Adult Treatment Panel III (ATPIII) 4 years ago (4). According to this definition, the metabolic syndrome is diagnosed in the presence of any three of five markers: central obesity, high triglycerides, low HDL cholesterol, high fasting glucose, and high blood pressure.Recently, the concept of the metabolic syndrome as an entity with clinical implications over and above its single constituents has been challenged (8,9). However, efforts continue to integrate the individual metabolic syndrome traits into an overall diagnosis, and the International Diabetes Federation (IDF) has now established a worldwide consensus definition of the metabolic syndrome (10,11).This new definition basically agrees with the component features of the ATPIII definition but introduces some important changes: the cutoff for a waist circumference defining central o...

Is Central Obesity a Good Predictor of Carotid Atherosclerosis in Japanese Type 2 Diabetes with Metabolic Syndrome?

“…OB: central obesity analysis. These findings are supported by a previous study revealing that waist circumference was not significantly predictive of vascular events after adjustment for the cardiovascular risk factors [25]. It is apparent that central obesity including visceral and subcutaneous fat defined by waist circumference, a surrogate marker of visceral obesity, is a significant independent predictor of insulin resistance, impaired glucose tolerance, hypertension and dyslipidemia seen in metabolic syndrome [26].…”

“…Therefore, the indispensability of central obesity of this new definition may be a cause of the reduced predictive power of carotid atherosclerosis. These findings are supported by recent several studies which revealed the lower predictive power of the IDF definition for CVD than NCEP-ATP III definition, and suggested that one cause of low predictive power for CVD was derived from the indispensability of the waist circumference component [25,32]. When central obesity was one of the components of metabolic syndrome, carotid IMT increased along with the increase in the number of the components of metabolic syndrome.…”

Prevalence of the metabolic syndrome among Korean adults using the new International Diabetes Federation definition and the new abdominal obesity criteria for the Korean people

“…In one prospective cohort study of 3589 British women free of coronary heart disease at baseline, both the IDF and NCEP definitions were similarly associated with coronary heart disease [19]. However, one prospective study of 20,789 men showed that the NCEP definition is more predictive of CVD mortality than the IDF definition [20], and another prospective study of 750 patients referred to coronary angiography reported that the NCEP definition significantly predicted cardiovascular events but, the IDF definition did not [21]. Further prospective research need to be conducted in order to clarify the predictive ability of the IDF and NCEP definitions for the development of cardiovascular disease.…”

Prevalência de síndrome metabólica em indivíduos brasileiros pelos critérios de NCEP-ATPIII e IDF

“…Nesse caso, a valorização da obesidade central pela IDF como parâmetro-diagnóstico, compreendendo valores de referência reduzidos para cintura abdominal comparados ao NCEP-ATPIII, parece justificar o aumento da prevalência da SM ora evidenciado 28 . No entanto, não necessariamente correspondendo maior efeito preditivo de complicações cardiovasculares, conforme demonstrado por Saely et al 33 . Além disso, a equivalência de padrões antropométricos proposta para populações distintas, vem sendo indicada como possível fator causador de viés nestas análi-ses 35 .…”