The usefulness of the International Diabetes Federation and the National Cholesterol Education Program's Adult Treatment Panel III definitions of the metabolic syndrome in predicting coronary heart disease in subjects with type 2 diabetes
The usefulness of the International Diabetes Federation and the National Cholesterol Education Program's Adult Treatment Panel III definitions of the metabolic syndrome in predicting coronary heart disease in subjects with type 2 diabetes
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DOI：
10.2337/dc06-1484
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发表时间：
2007-05-01
期刊：
影响因子：
16.2
通讯作者：
Cockram, Clive S.
中科院分区：
文献类型：
--
作者：
Tong, Peter C.;Kong, Alice P.;Cockram, Clive S.
目的-本研究的目的是比较国际糖尿病联合会（IDF）定义的冠心病（CHD）的预测价值在中国2型糖尿病受试者中，使用国家胆固醇教育计划（NCEP）成人治疗组III（ATP III）的现有标准（亚洲中心性肥胖标准）进行代谢综合征的研究。根据IDF和NCEP ATP III标准对患有2型糖尿病且无大血管疾病或终末期肾病的受试者进行分类。CHD被定义为心肌梗死、缺血性心脏病、冠状动脉血运重建、心力衰竭和与CHD相关的死亡。结果-在4，350例患者中（年龄54.4 ± 13.4岁;中位随访期7.1 [四分位数范围5.2-8.5]年），根据IDF或NCEP ATP III标准，65.9%的患者患有代谢综合征。NCEP ATP III定义确定了786例（18.1%）不符合IDF标准的受试者的代谢综合征。校正其他混杂因素后，高密度脂蛋白胆固醇和收缩压是冠心病的预测因子。与无代谢综合征的受试者相比，IDF标准未能预测CHD（风险比1。13 [95%CI 0.86 - 1.481，P = 0.374）。NCEP ATP III定义（2.51 [1.80 - 3.50]，P < 0.001）预测冠心病的危险性增加，仅NCEP组的危险性最高（2.49 [1.66-3.731，P < 0.001）。结论：对于确诊的2型糖尿病患者，IDF对代谢综合征的定义未能识别出CHD风险最高的患者亚组。从业者必须认识到其应用程序的适当设置。
OBJECTIVE - The purpose of this study was to compare the predictive value for coronary heart disease (CHD) of the International Diabetes Federation (IDF) definition (with Asian criteria for central obesity) of the metabolic syndrome with existing criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) in Chinese subjects with type 2 diabetes.RESEARCH DESIGN AND METHODS - Subjects with type 2 diabetes and without macrovascular diseases or end-stage renal disease were categorized by the criteria of the IDF and the NCEP ATP III. CHD was defined as myocardial infarction, ischemic heart disease, coronary revascularization, heart failure, and death related to CHD.RESULTS - Of 4,350 patients (aged 54.4 +/- 13.4 years; median follow-up period 7.1 [interquartile range 5.2-8.5] years), 65.9% had metabolic syndrome according to either IDF or NCEP ATP III criteria. The NCEP ATP III definition identified metabolic syndrome in 786 subjects (18.1%) who did not fulfill the criteria of the IDF. HDL cholesterol and systolic blood pressure were predictors of CHD after adjustment for other confounding factors. Compared with subjects without metabolic syndrome, the IDF criteria failed to predict CHD (hazard ratio 1. 13 [95% CI 0.86 -1.481, P = 0.374). In contrast, the NCEP ATP III definition (2.51 [1.80 -3.50], P < 0.001) predicted an increased risk of CHD with the NCEP-only group having the highest risk (2.49 [1.66-3.731, P < 0.001).CONCLUSIONS - With established type 2 diabetes, the IDF definition of the metabolic syndrome failed to identify a subgroup of patients who had the highest risk for CHD. Practitioners must recognize the appropriate setting for its application.