Prevalence and cardiovascular disease risk of the metabolic syndrome using National Cholesterol Education Program and International Diabetes Federation definitions in the Korean population

To compare the prevalence of the metabolic syndrome using the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) definitions and to contrast the association between the prevalence of cardiovascular disease and the metabolic syndrome using both definitions in the Korean population, we used data from the 2001 Korean Nation Health and Nutrition Survey, which is a nationally representative survey of the noninstitutionalized civilian population. The age-adjusted prevalence of the metabolic syndrome was 18.8%+/-0.5% (men, 17.8%+/-0.8%; women, 20.5%+/-0.7%) using the NCEP definition and 19.5%+/-0.5% (men 15.0%+/-0.8%, women 23.9%+/-0.7%) using the IDF definition among participants 20 years or older. The agreement rate, which is the percentage of participants who were classified as either having or not having the metabolic syndrome by both definitions of the metabolic syndrome, was 84.6%+/-0.5% (kappa=0.54). The prevalence of the metabolic syndrome using the NCEP definition was higher in participants with lower body mass index, whereas the prevalence using the IDF definition was higher in subjects with higher body mass index. The odds ratio (OR) for coronary artery disease was 3.5 (95% confidence interval [CI], 2.0-6.1) for participants with the metabolic syndrome defined by the NCEP definition, whereas it was 2.8 (95% CI, 1.6-5.0) for those with the metabolic syndrome defined by the IDF definition. Similarly, the OR for stroke was higher using the NCEP definition (OR, 3.0; 95% CI, 1.7-5.2) compared with that of the IDF definition (OR, 2.3; 95% CI, 1.3-4.0). However, the CIs by both definitions overlapped considerably. In conclusion, the prevalence of the metabolic syndrome using the IDF definition was higher than that using the NCEP definition, whereas the NCEP definition was more closely associated with cardiovascular disease in the Korean population.     

National Cholesterol Education Program and International Diabetes Federation definitions of metabolic syndrome in the prediction of diabetes. Results from the FIrenze-Bagno A Ripoli study

Background:  The International Diabetes Federation (IDF) proposed to modify the diagnostic criteria for metabolic syndrome (MS) previously issued by the National Cholesterol Education Program (NCEP). Aim of the present investigation is to compare the predictive value for diabetes of NCEP and IDF definitions of MS in a large sample of predominantly Caucasian subjects.
Methods:  A prospective observational study was performed on a cohort study (n = 3096) enrolled in a diabetes-screening programme, the FIrenze-Bagno A Ripoli study. All subjects with fasting glucose >126 mg/dl and/or post-load glucose ≥200 mg/dl (5.7%) were excluded from the present analysis. Follow-up of each subject was continued until diagnosis of diabetes, death or until 31 December 2005. Mean follow-up was 27.7 ± 11.3 months.
Results:  Among subjects enrolled, 13.7 and 25.2% were affected by MS using NCEP and IDF criteria respectively. During follow-up, 38 new cases of diabetes were diagnosed, with a yearly incidence rate of 0.5%. The relative risk for diabetes in subjects with MS was 10.10 [5.13; 20.00] and 7.87 [3.70; 16.7] using NCEP and IDF definitions respectively. After adjustment for age, sex, fasting glucose and waist circumference, NCEP-defined MS, but not IDF-, was significantly associated with incident diabetes (hazard ratio, 95% CI: 2.41 [1.01; 5.95] and 2.05 [0.80; 5.29] respectively).
Conclusions:  Although the reasons for the proposed changes in diagnostic criteria for MS are easily understandable, the newer IDF definition, while increasing estimates of prevalence of the syndrome, reduces the effectiveness of MS in identifying subjects at risk for diabetes. Further research is needed before the previous NCEP criteria are abandoned.     

Comparison of the prevalence of metabolic syndrome and its association with diabetes and cardiovascular disease in the rural population of Bangladesh using the modified National Cholesterol Education Program Expert Panel Adult Treatment Panel III and International Diabetes Federation definitions

Aims/Introduction

To compare the prevalence of metabolic syndrome (MS) using the modified National Cholesterol Education Program Adult Treatment Plan III (NCEP) and the International Diabetes Federation (IDF) definitions and, using both definitions, determine and compare the association of MS, prediabetes, type 2 diabetes, hypertension (HTN) and cardiovascular disease risk (CVD).

Materials and Methods

A total of 2,293 randomly selected participants (aged ≥20 years) in a rural community in Bangladesh were investigated in a population-based cross-sectional study. Sociodemographic and anthropometric characteristics, blood pressure, blood glucose, and lipid profiles were studied. Age-adjusted data for MS and cardiometabolic risk factors were assessed, and their relationships were examined.

Results

The age-adjusted prevalence of MS was 30.7% (males 30.5%; females 30.5%) using the NCEP definition, and 24.5% (males 19.2%, females 27.5%) using the IDF definition. The prevalence of MS using the NCEP definition was also higher in study participants with prediabetes, type 2 diabetes, HTN and CVD risk. The agreement rate between both definitions was 92% (k = 0.80). The NCEP definition had a stronger association with type 2 diabetes and HTN (odds ratio 12.4 vs 5.2; odds ratio 7.0 vs 4.7, respectively) than the IDF definition. However, the odds ratios for prediabetes and CVD risk were not significantly different.

Conclusions

The prevalence of MS was higher using the NCEP definition, and was more strongly associated with prediabetes, type 2 diabetes, HTN and CVD in this Bangladeshi population.     

Prevalence of metabolic syndrome estimated by International Diabetes Federation criteria in a Hungarian population

Aims. In recent years, metabolic syndrome (MS) became a distinct pathological entity. MS is positively associated with cardiovascular mortality. The prevalence of MS is high and a continuing increase is expected. For this reason, all attempts to prevent or manage MS by interventions are extremely important. The new set of definition by International Diabetes Federation (IDF) standardizes criteria for the diagnosis of MS and facilitates its recognition. In a large sample (n = 13 383) of outpatients visiting their general practitioners, we determined the prevalence of risk factors of MS according to the earlier Adult Treatment Panel (ATP) III and the new IDF criteria. Methods and results. The age-standardized prevalence of MS was 14.9% in males and 8.6% in females (11.5% for all). The most prevalent factors were obesity (ATP III: 38.8% and IDF: 60%) and hypertriglyceridemia (34.1%). Hypertension dominated in men (28.7%), whereas in women obesity was the most prevalent factor (ATP III: 47.4% and IDF: 64%). Conclusion. The prevalence of MS depends on applied definition. The new IDF criteria offer the possibility of focusing on the importance of different components. The real comparison of prevalence among special populations has to be based on age-standardized data and the use of the same components. In our study, the dominance of obesity, hypertension and hypertriglyceridemia appears to be the major detrimental factors. The 11.5% general prevalence of MS in Hungarians, which means a 25-30% value in the middle-aged population, needs an urgent preventive approach with lifestyle changes.     

国际糖尿病联盟与中华糖尿病学会关于代谢综合征定义的比较

221名存在代谢综合征（MS）风险者纳入研究。平均发现的MS组分数，国际糖尿病联盟（IDF）定义比中华糖尿病学会（CDS）定义略高（2．33us2．09，P〉0．05）。二者的诊断符合率为80％。女性的MS患病率，IDF定义（18／83）高于CDS定义（2／83）（P〈0．05）；但男性的MS诊断率，CDS定义（18／138）高于IDF定义（7／138）（P〈0．05）；血糖正常者诊断有MS的患病率，IDF定义（21／94，22％）高于CDS定义（10／97，10％）（P〈0．05）。CDS定义中有11例（12％）肥胖不达标者诊断MS。IDF不使用餐后血糖仅使MS漏诊6％。两种定义识别MS及其组分的能力基本相当；但与CDS定义相比，使用IDF定义能使患者群体发生以下几种漂移：从男性到女性，从糖代谢异常到脂代谢异常，从不肥胖到肥胖。     

Application of recent definitions of the metabolic syndrome to survey data from the National Cholesterol Education Program Evaluation Project Utilizing Novel E-Technology (NEPTUNE II)

This was a post hoc analysis of data collected in the National Cholesterol Education Program (NCEP) Evaluation Project Utilizing Novel E-Technology II (NEPTUNE II) survey conducted in 2003. Among 4885 dyslipidemic patients receiving lipid management in the United States, estimates of the prevalence of the metabolic syndrome according to the 2001 NCEP Third Adult Treatment Panel (ATP III), the 2005 American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement, and the 2005 International Diabetes Federation definitions were 55%, 62%, and 63%, respectively. Metabolic syndrome prevalence among patients with coronary heart disease and risk equivalents was 69%, 74%, and 74%, according to these respective definitions. Notably, in the coronary heart disease and risk equivalents category, the prevalence was similar to that of the multiple risk factor category when patients with diabetes mellitus were excluded from the analysis (46% by ATP III). The metabolic syndrome is common in patients receiving lipid-lowering therapy in an office-based setting. Three recent definitions resulted in similar estimates of its prevalence.     

Clustering of other metabolic risk factors in subjects with metabolic syndrome

Various anthropometric indices have been proposed for metabolic syndrome. We investigated the clustering of metabolic risk factors other than components of metabolic syndrome and physical activity in subjects with and without metabolic syndrome as defined by different anthropometric indices. The subjects comprised 6141 men and 2137 women who underwent routine health examinations in Tokyo. We compared metabolic risk factors (high low-density lipoprotein cholesterol, hyperuricemia, high γ-glutamyltransferase, fatty liver) and sedentary history in subjects with and without metabolic syndrome as defined by the American Heart Association by substituting various proposed anthropometric indices of abdominal obesity (waist circumference ≥85, ≥90, or ≥102 cm for men and ≥90, ≥80, or ≥88 cm for women; waist-to-height ratio ≥0.5 for both men and women). Irrespective of the anthropometric index or sex, the age-adjusted odds ratios for risk factors and sedentary history were all significantly greater in subjects with metabolic syndrome (men and women: 1.26∼1.35 and 2.06∼2.63 for high low-density lipoprotein cholesterol, 2.36∼2.60 and 3.88∼7.20 for hyperuricemia, 2.54∼3.02 and 2.92∼4.05 for high γ-glutamyltransferase, 4.42∼4.87 and 9.43∼12.27 for fatty liver, and 1.37∼1.50 and 1.43∼1.72 for sedentary history). Findings still persisted in those not receiving medication for diabetes mellitus or coronary heart disease. Therefore, attention should be paid to other metabolic risk factors in subjects with metabolic syndrome, irrespective of the anthropometric index or sex. Further study is also needed to clarify the most appropriate definition of metabolic syndrome so as to include the spectrum of risk factors that best represents the future risk of cardiovascular and other diseases.     

Waist circumference cutoff points for Chinese adults with metabolic syndrome defined by the International Diabetes Federation

Objective To investigate the appropriate waist circumference (WC) cutoff points for central obesity in the middle-aged and elderly Beijing residents by the metabolic syndrome definition of the International Diabetes Federation (IDF). Methods A total of 2,344 Beijing residents aged ≥40 years were investigated. They answered questionnaires, received physical examinations, and underwent plasma glucose and lipid profile measurement. Those non-diabetic subjects underwent a 75g oral glucose tolerance test. All data were analyzed to calculate the appropriate WC cutoff points for central obesity reaching the diagonsis of MS. Results 1) Both in males and females, the triglyceride (TG), systolic blood pressure, diastolic blood pressure and fasting plasma glucose (FPG) increased linearly with WC, and the high density lipoprotein cholesterol (HDL-C) decreased linearly with WC (P<0.05). 2)The prevalence of elevated TG, reduced HDL-C, elevated blood pressure, elevated FBG, or ≥ 2 of these factors increased with WC (P<0.05). 3) Based on the receiver operating characteristic (ROC) curve analysis and Youden index, the WC values for central obesity and for detecting BMI ≥ 25 kg/m2 were about 90 cm for men and 80 cm for women. 4) The odds ratio for the presence of two or more metabolic risk factors increased abruptly in men with WC ≥ 90 cm and in women with WC ≥ 80 cm. Conclusions The appropriate WC cutoff point for central obesity was determined to be 90 cm for men and 80 cm for women in the middle-aged and elderly Beijing residents by the metabolic syndrome definition of IDF.     

All-cause and cardiovascular mortality using the different definitions of metabolic syndrome

The aim of the present study was to assess the risk of all-cause and cardiovascular disease (CVD) mortality in subjects identified as having metabolic syndrome (MS) using either the recent International Diabetes Federation (IDF) definition or the revised National Cholesterol Educational Program (NCEP-R) definition, but not the original NCEP (2001) definition. The study population was composed of 84,730 men and women without CVD aged > or =40 years who had a health checkup at the IPC Center. Follow-up for mortality was 4.7 +/-1.7 years. Prevalences of MS were 9.6%, 21.6%, and 16.5% according to the NCEP, IDF, and NCEP-R definitions, respectively. Compared with subjects without MS, risks of all-cause mortality associated with MS were 1.63 (95% confidence interval [CI] 1.38 to 1.93) with the NCEP, 1.25 (95% CI 1.09 to 1.45) with the IDF, and 1.32 (95% CI 1.13 to 1.53) with the NCEP-R, and risks of CVD mortality were 2.05 (95% CI 1.28 to 3.28), 1.77 (95% CI 1.18 to 2.64), and 1.64 (95% CI 1.08 to 2.50), respectively. In subjects with MS detected using the IDF and NCEP-R definitions, but not the NCEP definition, risks of all-cause mortality were 1.07 (95% CI 0.89 to 1.28) and 0.92 (95% CI 0.73 to 1.18) and 1.42 (95% CI 0.86 to 2.34) and 1.07 (95% CI 0.55 to 2.09) for CVD mortality, respectively. In conclusion, in a large French population, the recent definitions of MS almost double the prevalence compared with the original definition. Subjects identified as having MS using only the recent definitions and not the original definition did not have higher rates of all-cause and CVD mortality compared with subjects without MS during follow-up.     

The hypertriglyceridemic waist phenotype versus the National Cholesterol Education Program-Adult Treatment Panel III and International Diabetes Federation clinical criteria to identify high-risk men with an altered cardiometabolic risk profile

The hypertriglyceridemic waist phenotype, the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria, and the International Diabetes Federation (IDF) criteria have been proposed as screening tools to identify subjects with features of the metabolic syndrome and therefore at increased cardiometabolic risk. The aim of the present study was to compare the ability of these 3 clinical approaches to identify individuals at increased cardiometabolic risk as suggested by the presence of deteriorated markers such as hyperinsulinemia, elevated apolipoprotein B levels, small low-density lipoprotein particles, high C-reactive protein concentrations, and low adiponectin levels. For that purpose, physical and cardiometabolic characteristics of a sample of 272 white men recruited for various metabolic investigations were studied. The hypertriglyceridemic waist phenotype was defined as having both a high waist circumference (≥90 cm) and increased fasting triglyceride levels (≥2.0 mmol/L). Having at least 3 of the 5 NCEP-ATP III criteria or waist circumference of at least 94 cm plus any 2 of the 4 additional IDF criteria was also used to identify individuals at increased cardiometabolic risk. A large proportion of men with the hypertriglyceridemic waist phenotype also met the NCEP-ATP III (82.7%) or IDF (89.2%) criteria. Men with the hypertriglyceridemic waist phenotype were characterized by alterations in their lipoprotein-lipid profile that included small low-density lipoprotein particles, increased apolipoprotein B and insulin levels, as well as reduced adiponectin concentrations, which were similar to individuals meeting the NCEP-ATP III or the IDF criteria. Moreover, the Framingham risk score of men meeting any of the 3 screening tools criteria was higher and was similar across the 3 approaches (4.2, 3.8, and 3.7, respectively). These results suggest that hypertriglyceridemic waist may be as discriminant as the NCEP-ATP III or the IDF criteria and could be used as an initial screening approach to identify individuals with deteriorated cardiometabolic risk markers.     

Concentration and relative distribution of low-density lipoprotein subfractions in patients with metabolic syndrome defined according to the National Cholesterol Education Program criteria

It has been proposed that the most common lipid abnormalities associated with the metabolic syndrome are elevated triglyceride and low high-density lipoprotein concentrations as well as the existence of small, dense low-density lipoprotein (LDL) particles. However, so far there are only limited clinical data concerning the distribution of LDL particles in patients with this syndrome. The aim of our study was to directly determine the concentration and relative distribution of LDL subfractions in patients with metabolic syndrome. One hundred seventy-five individuals were included. Patients with metabolic syndrome (n = 105) exhibited higher concentrations of dense LDL particles and lower mean LDL particle size than the control population (n = 70). Both of these parameters were significantly correlated with the number of components of metabolic syndrome. Multivariate analysis revealed that serum triglyceride concentration was the most important determinant of the presence of small, dense LDL particles. In conclusion, patients with metabolic syndrome exhibit higher concentrations of small, dense LDL subfractions than individuals who do not fulfill the criteria for the diagnosis of this syndrome. This increase is directly related to the number of components of metabolic syndrome and is mainly determined by the serum concentrations of triglycerides.     

Differences in prevalence and severity of coronary artery disease by three metabolic syndrome definitions

Background

People with metabolic syndrome (MS) are at increased risk for cardiovascular disease–associated morbidity and all-cause mortality. However, predicting the severity of coronary artery disease (CAD) according to different MS definitions is controversial. This study explores the prevalence and severity of CAD according to different MS definitions, focusing on their predictive value.

Methods

We enrolled 690 Taiwanese adults with CAD in this study. Coronary artery lesions were classified by the modified American Heart Association–American College of Cardiology grading system. MS was diagnosed in 3 groups of randomly assigned subjects according to World Health Organization (WHO), International Diabetes Federation (IDF), and revised Adult Treatment Panel III (rATP III) criteria.

Results

More MS components and more severe CAD were identified in the WHO group. Prevalence of MS in the WHO, IDF, and rATP III groups was 33.9%, 47.4%, and 52.8%, respectively (P < 0.001). Mean lesion and culprit vessel numbers were slightly higher in WHO-group patients. The WHO group had more complex stenoses with type C classification than did the IDF and rATP III groups (32.7%, 26.3%, and 28.1%; P = 0.041) and significantly more calcified stenoses (21.5%, 16.2%, and 16.4%; P = 0.027). In a comparison of CAD severity by complex morphology lesions, the area under the receiver operating characteristic curve was higher in the WHO group (0.552; 95% confidence interval, 0.509-0.595; P = 0.019).

Conclusion

Compared with IDF and rATP III definitions, the WHO definition of MS has superior predictive value of CAD severity in Taiwanese patients.     

Efficacy of atorvastatin in achieving National Cholesterol Education Program low-density lipoprotein targets in women with severe dyslipidemia and cardiovascular disease or risk factors for cardiovascular disease: The Women's Atorvastatin Trial on Cholesterol (WATCH)

BACKGROUND: Recent studies have demonstrated that women at high risk for cardiovascular disease (CVD) benefit from cholesterol lowering to an extent similar to that of men. The ability to achieve established treatment goals for low-density lipoprotein cholesterol (LDL-C) in women with clearly defined risk factors has not been examined in detail. METHODS AND RESULTS: We have determined the efficacy and frequency of achieving target levels for LDL-C with atorvastatin on the basis of National Cholesterol Education Program Adult Treatment Panel II recommendations in 318 women according to the presence of CVD (198 women) or risk factors for CVD (120 women) and the presence of mixed dyslipidemia with obesity with or without CVD (72 women). Mean baseline LDL-C concentrations for women with established CVD were in the upper 10% of the distribution for age-matched North American women and, for those without CVD, were also extremely elevated and were in the top 5% of the LDL-C distribution for age-matched women in this population. The majority of participants without CVD (63%) reached LDL-C targets (LDL-C or=2 CVD risk factors) with 10 mg atorvastatin and 79% reached targets with up to 20 mg of atorvastatin. For women with established CVD, 34% achieved an LDL-C 相似文献