Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies
Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies
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DOI：
10.1016/s0140-6736(08)60602-9
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发表时间：
2008-06-07
期刊：
影响因子：
168.9
通讯作者：
Wannamethee, S. Goya
中科院分区：
文献类型：
--
作者：
Sattar, Naveed;McConnachie, Alex;Wannamethee, S. Goya
背景临床上使用代谢综合征标准同时预测心血管疾病和糖尿病的风险仍然不确定。我们调查了老年人群中代谢综合征及其个体组分与这两种疾病风险的相关程度。（根据国家胆固醇教育计划第三次报告的标准定义）及其五个单独组成部分与4812名70岁以下非糖尿病个体发生心血管疾病和2型糖尿病事件的风险的关系。普伐他汀在老年高危人群中的前瞻性研究（PROSPER）82年。我们在针对2737名60-79岁非糖尿病男性的第二项前瞻性研究（英国区域心脏研究[BRHS]）中证实了这些数据。结果在PROSPER中，772例心血管疾病和287例糖尿病发生在3.2年内。代谢综合征与无基线疾病的患者心血管疾病风险增加无关（风险比1。07 [95% CI 0 .但与糖尿病风险增加相关（4.41 [3.33-5.84]），其各组分也是如此，尤其是空腹血糖（18.4 [13.9-24.5]）。在患有心血管疾病的参与者中，结果相似。在BRHS中，440例心血管疾病和105例糖尿病发生在7年以上。代谢综合征与心血管疾病的发生有一定的相关性（相对危险度为1.27 [1]）。04-1.56]），尽管与糖尿病密切相关（7.47 [4.90-11.46]）。在这两项研究中，体重指数或腰围、甘油三酯和葡萄糖临界点与心血管疾病的风险无关，但所有五个组成部分均与新发糖尿病的风险相关。这表明试图定义同时预测心血管疾病和糖尿病风险的标准是没有帮助的。临床的重点应该是为每种疾病建立最佳的风险算法。
Background Clinical use of criteria for metabolic syndrome to simultaneously predict risk of cardiovascular disease and diabetes remains uncertain. We investigated to what extent metabolic syndrome and its individual components were related to risk for these two diseases in elderly populations.Methods We related metabolic syndrome (defined on the basis of criteria from the Third Report of the National Cholesterol Education Program) and its five individual components to the risk of events of incident cardiovascular disease and type 2 diabetes in 4812 non-diabetic individuals aged 70-82 years from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). We corroborated these data in a second prospective study (the British Regional Heart Study [BRHS]) of 2737 non-diabetic men aged 60-79 years.Findings In PROSPER, 772 cases of incident cardiovascular disease and 287 of diabetes occurred over 3.2 years. Metabolic syndrome was not associated with increased risk of cardiovascular disease in those without baseline disease (hazard ratio 1 . 07 [95% CI 0 . 86-1.32]) but was associated with increased risk of diabetes (4.41 [3.33-5.84]) as was each of its components, particularly fasting glucose (18.4 [13.9-24.5]). Results were similar in participants with existing cardiovascular disease. In BRHS, 440 cases of incident cardiovascular disease and 105 of diabetes occurred over 7 years. Metabolic syndrome was modestly associated with incident cardiovascular disease (relative risk 1.27 [1 . 04-1.56]) despite strong association with diabetes (7.47 [4.90-11.46]). In both studies, body-mass index or waist circumference, triglyceride, and glucose cutoff points were not associated with risk of cardiovascular disease, but all five components were associated with risk of new-onset diabetes.Interpretation Metabolic syndrome and its components are associated with type 2 diabetes but have weak or no association with vascular risk in elderly populations, suggesting that attempts to define criteria that simultaneously predict risk for both cardiovascular disease and diabetes are unhelpful. Clinical focus should remain on establishing optimum risk algorithms for each disease.Funding Diabetes UK and British Heart Foundation.