Does the Metabolic Syndrome Improve Identification of Individuals at Risk of Type 2 Diabetes and/or Cardiovascular Disease?

University of Texas at San Antonio, San Antonio, Texas, United States
Diabetes Care (Impact Factor: 8.42). 12/2004; 27(11):2676-81. DOI: 10.2337/diacare.27.11.2676
Source: PubMed


The metabolic syndrome has been promoted as a method for identifying high-risk individuals for type 2 diabetes and cardiovascular disease (CVD). We therefore sought to compare this syndrome, as defined by the National Cholesterol Education Program, to the Diabetes Predicting Model and the Framingham Risk Score as predictors of type 2 diabetes and CVD, respectively.
A population-based sample of 1,709 initially nondiabetic San Antonio Heart Study (SAHS) participants were followed for 7.5 years, 195 of whom developed type 2 diabetes. Over the same time interval, 156 of 2,570 SAHS participants experienced a cardiovascular event. A population-based sample of 1,353 initially nondiabetic Mexico City Diabetes Study (MCDS) participants were followed for 6.5 years, 125 of whom developed type 2 diabetes. Baseline measurements included medical history, age, sex, ethnicity, smoking status, BMI, blood pressure, fasting and 2-h plasma glucose levels, and fasting serum total and HDL cholesterol and triglycerides.
The sensitivities for predicting diabetes with the metabolic syndrome were 66.2 and 62.4% in the SAHS and the MCDS, respectively, and the false-positive rates were 27.8 and 38.7%, respectively. The sensitivity and false-positive rates for predicting CVD with the metabolic syndrome in the SAHS were 67.3 and 34.2%, respectively. At corresponding false-positive rates, the two predicting models had significantly higher sensitivities and, at corresponding sensitivities, significantly lower false-positive rates than the metabolic syndrome for both end points. Combining the metabolic syndrome with either predicting model did not improve the prediction of either end point.
The metabolic syndrome is inferior to established predicting models for either type 2 diabetes or CVD.

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    • "Robust evidence showed that individuals diagnosed with MetS using these definitions have a greater risk of significant clinical consequences, the two most prominent of which are the development of T2DM and CVD [12] [13] [14] [15]. Individuals with MetS have a fivefold greater risk of developing T2DM [12], while a systematic review of 37 studies involving more than 170,000 patients has shown that MetS doubles the risk of cardiovascular events [15]. Irrespective of the diagnostic criteria used, epidemiological studies from various parts of the world have clearly demonstrated that MetS is an increasing global health problem , not only in the western societies, but also in the Asian populations [16] [17]. "

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    • "Job stress is associated with cardiovascular morbidity (CVD) and mortality, and the metabolic syndrome (MetS) represents a major pathway potentially underlying these associations [1] [2] [3] [4] [5] [6] [7]. MetS refers to a cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, that includes central obesity, impaired glucose metabolism, insulin resistance, dyslipidemia and hypertension [8] [9]. Individuals with the MetS are at a two-fold increased risk of developing CVD and at a 5-fold elevated risk of incident type 2 diabetes mellitus [9] [10]. "
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    ABSTRACT: Background/objectives: Job stress is a predictor of cardiovascular disease incidence andmortality and the metabolic syndrome (MetS) represents one of the key pathways potentially underlying those associations. Effort–reward imbalance (ERI) represents one of the most influential theoretical work stress models, but evidence on its relationship with MetS remains sparse and with only limited generalizability. We therefore aimed to determine this association in a large occupational sample with different occupational groups. Methods: The present study used cross-sectional data from an industrial sample in Germany (n= 4141). ERI was assessed by a validated 10-item questionnaire. MetS was defined according to a joined interim statement of six expert associations involved with MetS, stating that three out of five risk factors (raised blood pressure, elevated triglycerides, low high density lipoprotein, raised fasting glucose and central obesity) qualify a patient for MetS. Multivariable associations of ERI, and its subcomponents “effort” and “reward”, withMetS were estimated by logistic regression-based multivariate odds ratios (ORs) with 95% confidence intervals (CIs). Results: ERI (continuous z-score) was positively associated with MetS (zERI: OR = 1.14, 95% CI = 1.03–1.26). The association was more prominent in males (zERI: OR 1.20, 95% CI = 1.07–1.33) and in younger employees (age 18–49 zERI: OR= 1.24, 95% CI= 1.09–1.40). Analysis of the ERI subcomponents yielded weak associations of both effort (zEffort: OR= 1.12, 95% CI= 1.00–1.25) and reward (zReward: OR= 0.92, 95% CI= 0.84–1.00) with MetS. Conclusions: ERI is associated with increased occurrence ofMetS, in particular among younger men. Further longitudinal studies are needed to determine the temporal relation of these associations.
    International Journal of Cardiology 11/2014; 178:24-28. DOI:10.1016/j.ijcard.2014.10.115 · 4.04 Impact Factor
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    • "The metabolic syndrome (MetS) as defined by the International Diabetes Federation (IDF) is a constellation of the most dangerous risk factors of heart attack including diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and high blood pressure [1-3]. Globally, 20-25% of the adult population has been estimated to have the MetS and are twice as likely to die from and three times as likely to have a heart attack or stroke compared with people without the syndrome [4]. "
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    ABSTRACT: Background Adults with the metabolic syndrome (MetS) are twice as likely to die from and three times as likely to have a heart attack or stroke compared with people without the syndrome. About 70-80% of type 2 diabetes mellitus (type 2 DM) patients are diagnosed with the MetS. Investigating the occurrence of the MetS in type 2 DM patients is critical for cardiovascular disease prevention. We evaluated the prevalence and components of the MetS and its associated clinical and demographic factors in a Ghanaian adult population with DM 2. Methods This cross-sectional study was conducted among 200 previously diagnosed type 2 DM patients receiving care from an outpatient clinic of the Tamale Teaching Hospital, Ghana. Anthropometric measurements of waist circumference (cm), weight (Kg) and height (m) were measured appropriately. Clinical data were obtained from the personal health record files of the participants. MetS was defined according to the International Diabetes Federation criteria. Results The prevalence of MetS was 24.0% (n=48). The prevalence was higher in women (27.3%, n= 42) compared to men (13.0%, n=6). The commonest occurring components of the MetS included abdominal obesity (77.0%) and elevated FPG (77.0%) denoting uncontrolled diabetes. The prevalence of elevated BP was found to be 44.0%(n=88) and was higher in men (56.5%) than in women (40.3%). Factors that were found to be associated to the MetS were being overweight/obese (Crude OR = 2.9, 95% CI = 1.43 – 5.90, p=0.004), ever tried to lose weight (Crude OR = 2.5, 95% CI = 1.24 – 4.94, p=0.015) and having diabetes for over 5 years (Crude OR = 11.3, 95% CI = 5.26 – 24.08, p<0.001). Other factors that were associated to the MetS were current smokers (Crude OR = 6.8, 95% CI = 1.21- 38.49, p=0.030) and alcohol drinkers (Crude OR = 3.1, 95% CI = 1.23 – 7.65, p=0.018). Conclusion A comparatively low prevalence of the MetS was found. More females than males had the MetS. Uncontrolled diabetes and abdominal obesity were prevalent. The factors identified by our univariate logistic regression model were not significant predictors of the MetS in our multivariate model.
    Journal of Diabetes and Metabolic Disorders 07/2014; 13(1):80. DOI:10.1186/2251-6581-13-80
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