Quantitative Epidemiologic Assessment of the Metabolic Syndrome Definition

代谢综合征定义的定量流行病学评估

• 批准号: 7470402
• 负责人: Rachel P Wildman
• 金额: $ 20.75万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7470402
• 关键词: Address; Adult; Affect; African American; Atherosclerosis; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Caucasians; Caucasoid Race; Classification; Clinical; Cohort Studies; Communities; Data; Databases; Diabetes Mellitus; Endocrinologist; Epidemiologist; Equation; Ethnic Origin; Event; Exhibits; Expert Opinion; Fasting; Funding; Future; Gender; Glucose; Health; Hypertension; Individual; International; Literature; Longitudinal Studies; Metabolic syndrome; Methodology; Numbers; Performance; Plasma; Population; Predictive Value; Public Health; Publishing; Race; Research; Risk; Risk Factors; Scheme; Score; Sensitivity and Specificity; Side; Stratification; Subgroup; Syndrome; Woman; base; cardiovascular disorder prevention; cardiovascular disorder risk; concept; experience; men; mortality; non-diabetic; normotensive; novel; prospective; tool

DESCRIPTION (provided by applicant): Considerable debate is occurring over the clinical utility of the metabolic syndrome concept, despite a large volume of published literature concerning its associations with cardiovascular disease (CVD). A number of different definitions for the metabolic syndrome have been proposed, each derived primarily from expert opinion rather than from quantitative optimization of syndrome components and cutpoints. Prospective data are lacking comparing the accuracy of those definitions in the classification and prediction of incident CVD, examining whether the syndrome confers any additional risk information above its individual components and above clinical risk tools such as the Framingham Risk Score, and examining whether the metabolic syndrome imparts the same CVD risk information among gender and race-ethnic subgroups. To address these limitations, we propose to pool existing data from 4 large, population-based, NHLBI-supported, longitudinal studies: The Atherosclerosis Risk in Communities Study (ARIC), the Cardiovascular Health Study (CHS), the Framingham Cohort Study, and the Framingham Offspring Study. This pooled database will allow for the first quantitative determination of the optimal metabolic syndrome definition and assessment of its accuracy as a CVD risk predictor. This R21 application has 3 specific aims: 1.) To determine a novel definition of the metabolic syndrome that is optimal in terms of its sensitivity and specificity for predicting incident CVD events and all-cause mortality, including determining a.) The most appropriate cut points for each of the components of the metabolic syndrome, and b.) The appropriate number and combination of components for designation of the metabolic syndrome, 2.) To compare the ability of various risk stratification schemes to predict incident CVD events and all-cause mortality, including: a.) the Adult Treatment Panel (ATP) III metabolic syndrome definition, b.) The International Diabetes Federation (IDF) metabolic syndrome definition, c.) The optimal definition of the metabolic syndrome as identified in Aim 1, d.) The individual metabolic syndrome components and e.) The Framingham Risk Score equation and 3.) To examine the performance of the ATP III, IDF, and optimal metabolic syndrome definitions in predicting incident CVD events and all-cause mortality among subgroups defined by: a.) gender, b.) race-ethnicity, and c.) presence or absence of major risk factors including diabetes and hypertension. Through the pooling of these large databases and the aims above, we will be using statistical methodologies that consider both the strength of the association between the metabolic syndrome and CVD events, as well as the accuracy of the metabolic syndrome to classify individuals who subsequently develop CVD, within the framework of prospective data. This will provide the first truly comprehensive assessment of the syndrome's definition and predictive abilities. This study will provide the experts engaged in the debate on the clinical utility of the metabolic syndrome with information critical to making an evidence-based, data-driven decision. PUBLIC HEALTH RELEVANCE Between 25% and 40% of adults has been shown to have the metabolic syndrome, based on current syndrome definitions. The data concerning the cardiovascular disease risk prediction capabilities of the metabolic syndrome provided by the current application will provide critical information to making an evidence- based decision regarding the clinical utility of the metabolic syndrome. Therefore, given the large proportion of the population affected by the syndrome, this application could have a significant impact on the practice of cardiovascular disease prevention.

描述(由申请人提供)：关于代谢综合征概念的临床应用，尽管已发表了大量关于其与心血管疾病(CVD)的关系的文献，但仍存在相当大的争论。对代谢综合征提出了许多不同的定义，每一种都主要来自专家的意见，而不是来自对症状成分和切点的量化优化。缺乏前瞻性数据来比较这些定义在事件心血管疾病分类和预测中的准确性，检查综合征是否在其个别组成部分和临床风险工具(如Framingham风险评分)之上提供任何额外的风险信息，以及检查代谢综合征是否在性别和种族亚组中传递相同的心血管疾病风险信息。为了解决这些局限性，我们建议汇集4项大型、基于人群、NHLBI支持的纵向研究的现有数据：社区动脉粥样硬化风险研究(ARIC)、心血管健康研究(CHS)、Framingham队列研究和Framingham子孙研究。这个汇集的数据库将允许首次定量确定最佳代谢综合征定义，并评估其作为心血管疾病风险预测指标的准确性。此R21应用程序有3个具体目标：1.确定代谢综合征的新定义，该定义对于预测心血管事件和全因死亡率的敏感度和特异度是最佳的，包括确定。)代谢综合征的每个组成部分的最合适的切入点，以及b。)用于指定代谢综合征的适当数量和组件组合，2.)比较各种风险分层方案预测心血管事件和全因死亡率的能力，包括：a.)成人治疗小组(ATP)III代谢综合征定义，b.)国际糖尿病联合会(IDF)代谢综合征定义，c.)目标1，d.所确定的代谢综合征的最佳定义)个体代谢综合征成分和e。)Framingham风险评分方程和3。)检查ATPIII、IDF和最佳代谢综合征定义在预测突发心血管事件和由下列因素定义的亚组中的全因死亡率方面的表现：a.)性别，b)种族-民族，以及c.)存在或不存在主要危险因素，包括糖尿病和高血压。通过汇集这些大型数据库和上述目标，我们将使用统计方法，既考虑代谢综合征和心血管疾病事件之间的相关性的强度，也考虑代谢综合征的准确性，以在预期数据的框架内对随后发展为心血管疾病的个人进行分类。这将为综合症的定义和预测能力提供第一次真正全面的评估。这项研究将为参与代谢综合征临床效用辩论的专家提供关键信息，以做出以证据为基础、数据驱动的决策。根据目前的综合症定义，25%至40%的成年人患有代谢综合征，这与公共卫生有关。当前应用程序提供的有关代谢综合征心血管疾病风险预测能力的数据将为关于代谢综合征临床效用的循证决策提供关键信息。因此，考虑到受该综合征影响的人口比例很大，这种应用可能会对心血管疾病预防的实践产生重大影响。