A Gender-Stratified Comparative Analysis of Various Definitions of Metabolic Syndrome and Cardiovascular Risk in a Multiethnic U.S. Population

Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA.
Metabolic syndrome and related disorders (Impact Factor: 1.98). 02/2012; 10(1):47-55. DOI: 10.1089/met.2011.0087
Source: PubMed


We sought to evaluate the ability of various metabolic syndrome definitions in predicting primary cardiovascular disease (CVD) outcomes in a vast multiethnic U.S. cohort.
This study included 6,814 self-identified men and women aged 45-84 years enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) study. Gender-stratified analyses were performed to calculate hazard ratios of CVD, stroke, and mortality associated with various metabolic syndrome definitions and their individual constructs.
The hazard ratios [95% confidence interval (CI)] for all-cause CVD in men were 2.90 (2.18-3.85), 2.64 (1.98-3.51), 2.16 (1.62-2.88), 2.56 (1.91-3.44), 1.82 (1.35-2.46), and 2.92 (2.15-3.95) for the National Cholesterol Education Program (NCEP), American Heart Association (AHA), World Health Organization (WHO), International Diabetes Federation (IDF), European Group for the Study of Insulin Resistance (EGIR), and the newly defined consensus criteria. Hazard ratios in women were 2.11 (1.41-3.15), 2.17 (1.45-3.27), 2.04 (1.37-3.06), 1.91 (1.27-2.88), 1.85 (1.23-2.79), and 2.08 (1.37-3.14), respectively. Metabolic syndrome was strongly associated with stroke risk only in males. In men, all constitutive metabolic syndrome components were continuously and strongly associated with CVD. In women, high-density lipoprotein and triglycerides did not appear to be associated with short term CVD risk.
We found the newly defined consensus criteria for metabolic syndrome to be similarly predictive of cardiovascular events when compared to existing definitions. Significant gender differences exist in the association between metabolic syndrome, its individual components, and CVD.

Download full-text


Available from: Rajeev Sudhakar, Dec 27, 2013
  • Source
    • "The CHAID analysis did not identify any significant differences in MetS based on sex or ethnicity in this sample although previous studies have shown differences in MetS risk based on sex and ethnicity [24, 25]. Considering the limitation of the current study, future investigations warrant utilizing sufficiently large sample sizes, considering the difference in MetS based on the sex and ethnicity and performing model validation. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Metabolic syndrome (MetS) in young adults (age 20–39) is often undiagnosed. A simple screening tool using a surrogate measure might be invaluable in the early detection of MetS. Methods. A chi-squared automatic interaction detection (CHAID) decision tree analysis with waist circumference user-specified as the first level was used to detect MetS in young adults using data from the National Health and Nutrition Examination Survey (NHANES) 2009-2010 Cohort as a representative sample of the United States population ( n = 745 ) . Results. Twenty percent of the sample met the National Cholesterol Education Program Adult Treatment Panel III (NCEP) classification criteria for MetS. The user-specified CHAID model was compared to both CHAID model with no user-specified first level and logistic regression based model. This analysis identified waist circumference as a strong predictor in the MetS diagnosis. The accuracy of the final model with waist circumference user-specified as the first level was 92.3% with its ability to detect MetS at 71.8% which outperformed comparison models. Conclusions. Preliminary findings suggest that young adults at risk for MetS could be identified for further followup based on their waist circumference. Decision tree methods show promise for the development of a preliminary detection algorithm for MetS.
    Full-text · Article · Apr 2014 · Computational and Mathematical Methods in Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Gender differences were documented for several diseases. This might influence treatment costs for the insurance companies as well as reimbursement of the health care facilities. This manuscript deals with the possible economic implications of gender-related differences in cardiovascular medicine. Methods: A systematical review of the literature reporting the impact of gender on health care costs with special focus on cardiovascular medicine. Results: Women cause higher health care costs during their lifetime, but large part of the difference compared with men is caused by pregnancy and birth, not by diseases. However, after subtracting the costs for pregnancy and birth, there still remains a difference with higher costs for women, although the origin of this disparity is not definitely clear up to date. In cardiovascular medicine, especially the risk factor metabolic syndrome including diabetes had a higher prevalence in women and was shown to have a greater impact on cardiovascular disease compared with men. This concerned both costs and outcome. But in contrast to this, women experienced poorer preventive treatment of their metabolic syndrome, especially with regards to lipid levels. This influenced the costs of hospital treatment as well as the prognosis, for example, following coronary bypass grafting. Comments: The higher influence of several risk factors on cardiovascular disease in women should lead to improved preventive strategies in female patients. Further research is necessary to give more evidence for gender-related differences within the impact of several risk factors on treatment costs. This could then also influence reimbursement strategies taking these gender disparities into account.
    No preview · Article · Dec 2012 · The Thoracic and Cardiovascular Surgeon
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a critical resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best available national data on heart disease, stroke, and other cardiovascular disease-related morbidity and mortality and the risks, quality of care, use of medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions. In 2012 alone, the various Statistical Updates were cited ≈3500 times (data from Google Scholar). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled. For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year. This year's edition includes a new chapter on peripheral artery disease, as well as new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Update.
    Full-text · Article · Dec 2012 · Circulation
Show more