Modification of the NCEP ATP III definitions of the metabolic syndrome for use in Asians identifies individuals at risk of ischemic heart disease

Heng, Derrick; Ma, Stefan; Lee, Jeannette J.M.; Tai, Bee Choo; Mak, Koon Hou; Hughes, Kenneth; Chew, Suok Kai; Chia, Kee Seng; Tan, Chee Eng; Tai, E Shyong

doi:10.1016/j.atherosclerosis.2005.07.020

Cited by 122 publications

(95 citation statements)

References 30 publications

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“…Diabetes mellitus was also more prevalent in Asian Indians than other ethnic groups, a finding which is in line with the findings of several previous studies [12-14, 18, 22]. We and others have shown that Asian Indians, compared with those in other ethnic groups, are also more insulin-resistant [13,14,23,24] and exhibit more risk factors associated with insulin resistance and the metabolic syndrome [25,26]. The cause of this greater propensity to develop insulin resistance and diabetes mellitus is unclear at this time.…”

Section: Discussionsupporting

confidence: 91%

Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore

et al. 2006

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Aims/hypothesis The aim of the study was to determine whether the risk of ischaemic heart disease (IHD) associated with diabetes mellitus differs between ethnic groups. Methods Registry linkage was used to identify IHD events in 5707 Chinese, Malay and Asian Indian participants from three cross-sectional studies conducted in Singapore between the years 1984 and 1995. The study provided a median of 10.2 years of follow-up with 240 IHD events experienced. We assessed the interaction between diabetes mellitus and ethnicity in relation to the risk of IHD events using Cox proportional hazards regression. Results Diabetes mellitus was more common in Asian Indians. Furthermore, diabetes mellitus was associated with a greater risk of IHD in Asian Indians. The hazard ratio when comparing diabetes mellitus with non-diabetes mellitus was 6.41 (95% CI 5.77-7.12) in Asian Indians and 3.07 (95% CI 1.86-5.06) in Chinese (p=0.009 for interaction). Differences in the levels of established IHD risk factors among diabetics from the three ethnic groups did not appear to explain the differences in IHD risk. Conclusions/interpretation Asian Indians are more susceptible to the development of diabetes mellitus than Chinese and Malays. When Asian Indians do develop diabetes mellitus, the risk of IHD is higher than for Chinese and Malays. Consequently, the prevention of diabetes mellitus amongst this ethnic group is particularly important for the prevention of IHD in Asia, especially given the size of the population at risk. Elucidation of the reasons for these ethnic differences may help us understand the pathogenesis of IHD in those with diabetes mellitus.

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Section: Discussionsupporting

confidence: 91%

Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore

et al. 2006

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“…In Asians, the criterium for waist circumference was modified to 90 cm for men and 80 cm for women from the original NCEP ATP , leading to an increase in frequency of MS in both men and women 13,14) . Furthermore, Heng et al demonstrated that subjects who satisfied the modified Asian criteria (waist circumference 90 cm for men and 80 cm for women) but not the NCEP ATP criteria, were also at increased risk for ischemic heart disease 27) . Takeuchi et al have shown that subjects with MS diagnosed with the Japanese criteria 28) (waist circumference of 85 cm for men and 90 cm for women) had a 2.2-fold greater risk of developing cardiac disease than subjects without MS 29) .…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of Metabolic Syndrome by Modified NCEP-ATPIII Criteria on Carotid Atherosclerosis in Japanese Adults

Teramura

Emoto

Araki

et al. 2007

JAT

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“…24 In contrast, data from Singapore have indicated that up to one half of the adult population have suboptimal HDL-C levels. 25 The high prevalence of low HDL-C present in these populations may partly explain why migrant studies have shown that South Asians have between 50% and 200% higher CHD rates compared with European populations even after adjustment for conventional risk factors such as smoking, BP, and total cholesterol. 26,27 These results suggest that treatment strategies aiming to increase HDL-C levels might be particularly important in Asia.…”

Section: Huxley Et Al Isolated Low Hdl Cholesterol and Chd Risk 2061mentioning

confidence: 99%

Isolated Low Levels of High-Density Lipoprotein Cholesterol Are Associated With an Increased Risk of Coronary Heart Disease

Barzi²,

et al. 2011

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Background— Previous studies have suggested that there is a novel dyslipidemic profile consisting of isolated low high-density lipoprotein cholesterol (HDL-C) level that is associated with increased risk of coronary heart disease, and that this trait may be especially prevalent in Asian populations. Methods and Results— Individual participant data from 220 060 participants (87% Asian) in 37 studies from the Asia-Pacific region were included. Low HDL-C (HDL <1.03 mmol/L in men and <1.30 mmol/L in women) was seen among 33.1% (95% confidence interval [CI], 32.9–33.3) of Asians versus 27.0% (95% CI, 26.5–27.5) of non-Asians ( P <0.001). The prevalence of low HDL-C in the absence of other lipid abnormalities (isolated low HDL-C) was higher in Asians compared with non-Asians: 22.4% (95% CI, 22.2–22.5) versus 14.5% (95% CI, 14.1–14.9), respectively ( P <0.001). During 6.8 years of follow-up, there were 574 coronary heart disease and 739 stroke events. There was an inverse relationship between low HDL-C with coronary heart disease in all individuals (hazard ratio, 1.57; 95% CI, 1.31–1.87). In Asians, isolated low levels of HDL-C were as strongly associated with coronary heart disease risk as low levels of HDL-C combined with other lipid abnormalities (hazard ratio, 1.67 [95% CI, 1.27–2.19] versus 1.63 [95% CI, 1.24–2.15], respectively). There was no association between low HDL-C and stroke risk in this population (hazard ratio, 0.95 [95% CI, 0.78 to 1.17] with nonisolated low HDL-C and 0.81 [95% CI, 0.67–1.00] with isolated low HDL-C). Conclusion— Isolated low HDL-C is a novel lipid phenotype that appears to be more prevalent among Asian populations, in whom it is associated with increased coronary risk. Further investigation into this type of dyslipidemia is warranted.

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Modification of the NCEP ATP III definitions of the metabolic syndrome for use in Asians identifies individuals at risk of ischemic heart disease

Cited by 122 publications

References 30 publications

Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore

Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore

Clinical Impact of Metabolic Syndrome by Modified NCEP-ATPIII Criteria on Carotid Atherosclerosis in Japanese Adults

Isolated Low Levels of High-Density Lipoprotein Cholesterol Are Associated With an Increased Risk of Coronary Heart Disease

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