Metabolic Syndrome in Blacks: Are the Criteria Right?

Abstract

Blacks have a lower prevalence of metabolic syndrome (MetS) that can be partly ascribed to the lower prevalent rates of some major components of MetS, namely the lower serum triglycerides and higher high-density lipoprotein cholesterol levels in blacks when compared with whites. Blacks manifest greater insulin resistance, the pivotal lesion underpinning MetS than whites. However, the relationships among insulin resistance and cardiovascular disease (CVD) risk factors are weaker in blacks than whites. The international bodies have recommended the use of European-based cutoff points for MetS for blacks. However, with the emerging inconsistencies in the association of insulin resistance and CVD risk factors in blacks, the use of these definitions and the cutoff points for MetS have become problematic. Therefore, it is important to review the limitations in the use of the current criteria and cutoff points of MetS in blacks to lessen the CVD risk burden in blacks.

Triglyceride-Based Screening Tests Fail to Recognize Cardiometabolic Disease in African Immigrant and African-American Men

“…[11][12][13] In growing recognition of the failure of the metabolic syndrome to detect risk for cardiometabolic disease in African Americans, the 2012 Endocrine Society Position Statement on Health Disparities suggests moving away from the metabolic syndrome and focusing instead on blood pressure and degree of glycemia. 16 Due to the similarities that we have demonstrated between African Americans and African immigrants, the same approach should be applied to Africans.…”

“…Blood samples for the measurement of glucose and insulin levels were obtained at -10, -5, -1, 1, 2, 3,4,5,6,7,8,10,12,14,16,19,22,23,24,25,27,30,40,50,60,70,80,90, 100, 120, 150, and 180 min. IM-FSIGT data were used to calculate the insulin sensitivity index (S I ) and acute insulin response to glucose (AIRg).…”

“…[2][3][4][5] However, in contrast to whites, Hispanics, and Asians, TG levels in African Americans with cardiometabolic disease are typically normal. [6][7][8][9][10][11][12][13][14][15] Therefore, TG-based tests usually fail to recognize African Americans at risk. 16 It is possible that the African-American experience with cardiometabolic disease screening will forecast the African experience.…”

“…Insulin-resistant African Americans are much more likely than whites or Hispanics to have normal TG levels. [12][13][14]22 Therefore, cardiometabolic disease in African Americans develops due to TG-independent pathways such as inflammation, endothelial dysfunction, and hypertension. 23,24 Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.…”

The Impact of Race and Comorbidity on Survival in Endometrial Cancer

“…For example, the metabolic syndrome is a risk factor for development of diabetes as well as cardiovascular disease. Although blacks are at higher risk of diabetes than whites, they are unlikely to share 2 of the 5 established markers of metabolic syndrome, high triglycerides, and low high-density lipoprotein cholesterol (26). In addition, among patients receiving dialysis for end-stage renal disease, most of whom have an underlying diagnosis of diabetes, blacks have more favorable survival than whites (27).…”