Evaluating CMR

The Strong Heart Study

In the 10 year longitudinal follow-up of the Strong Heart Study, de Simone et al. (7) compared the ability of WHO, NCEP-ATP III, and IDF criteria to predict CVD events in 2,825 asymptomatic individuals (1,700 individuals had diabetes at the beginning of follow-up). In diabetic and non-diabetic men, metabolic syndrome prevalence was 48%, 44%, and 59% using WHO, NCEP-ATP III, and IDF screening tools. In women, the respective prevalence was 53%, 63%, and 73%. In participants without diabetes, the HRs for incident CVD were 1.54 (95% CI, 1.32-1.80), 1.42 (95% CI, 1.22-1.66), and 1.37 (95% CI, 1.17-1.61) for WHO, NCEP-ATP III, and IDF criteria, respectively. The HRs were definitely higher in participants with diabetes, reaching 2.29 (95% CI, 1.97-2.67), 2.45 (95% CI, 2.12-2.84), and 2.59 (95% CI, 2.25-2.98). Coefficients of concordance varied widely. The strongest coefficient of concordance was between NCEP-ATP III and IDF criteria in women (κ=0.77), while the poorest coefficient of concordance was between IDF and WHO criteria in men (κ=0.49).