Does the constellation of risk factors with and without abdominal adiposity associate with different cardiovascular mortality risk?

Abstract

The DECODE Study GroupAims: To evaluate whether the metabolic syndrome (MetS) defined by the International Diabetes Federation (IDF) criteria, which has abdominal adiposity as a mandatory element, predicts cardiovascular disease (CVD) mortality better than the cluster of other IDF-defined abnormalities not including abdominal adiposity. Methods: Data from nine European population-based studies, including 7782 men and 7739 women (aged 30-89 years), with a median follow-up of 8.55 years, were jointly analyzed. Hazard ratios for CVD mortality were calculated with Cox regression models. Results: In total, 41% of the men and 38% of the women had the IDF MetS. Individuals with the IDF MetS were by definition more obese and had a higher prevalence of diabetes than non-obese subjects with X2 IDF abnormalities; whereas non-obese men with X3 factors had more atherogenic lipid profiles. Multivariate adjusted hazard ratio for CVD death in men and women with the IDF MetS was 2.44 (1.69-2.98) and 2.32 (1.27-4.23); in non-obese men with 2 and X3 factors the hazard ratio was 1.60 (1.12-2.30) and 2.44 (1.62-3.66), respectively, and in non-obese women with 2 factors the hazard ratio was 2.41 (1.09-5.33). Conclusions: The cluster of the CVD risk factors predicted CVD mortality regardless of the presence or absence of the abdominal adiposity. Inclusion of abdominal adiposity as a prerequisite will miss those non-obese individuals who have increased CVD mortality.

Adiposity and risk of cardiovascular diseases in Japan: secular trend, individual level associations and causal pathway – implications for the prevention of cardiovascular diseases in societies with rapid economic development

“…To maximize public health, the tool used must not overlook a substantial proportion of high-risk individuals, who eventually develop the conditions. In a European population-based study, non-obese people with two or more IDF MetS factors were less prevalent than IDF MetS individuals, but their CVD mortality rate was comparable to that of individuals with IDF MetS [52]. The PAF calculated from the data was 10.0% for men with two or more risk factors without abdominal obesity and 28.2% for men that met IDF MetS criteria.…”

A Japanese health success story: trends in cardiovascular diseases, their risk factors, and the contribution of public health and personalized approaches

“…The population attributable risk fraction (the percentage of preventable disease by control of target exposure) was similar or even greater in non-obese individuals with two risk factors than those with metabolic syndrome. The pitfalls for the application of the Japanese or International Federation of Diabetes criteria in predictive, preventive, and personalized medicine have also been addressed by other Japanese, Korean, and European studies [59–63], and are discussed by Yatsuya H. et al in the present issue of the EPMA journal [48].

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Abnormal Microcirculation and Red Blood Cell Function as a Cardiovascular Risk Factor in Metabolic Syndrome

“…Установлено, что больные даже с неполным набором клинических проявлений МС имеют значительно более высокий риск сердечно-сосудистых заболеваний по сравнению со здоровыми людьми. По результатам крупных исследований у пациентов с сочетанием абдоминального ожирения и 2-х компонентов МС относительный риск сердечно-сосудистых осложнений повышается в 2,2-2,3 раза, причем данный риск не снижается при сочетании 3-х компонентов МС в отсутствие ожирения [8]. Относительный риск смерти от сердечно-сосудистых осложнений при наличии 3-х компонентов МС составляет 1,51, а при сочетании всех 5-ти состояний -2,98 [9].…”