Evaluating CMR

How are screening tools different?

Although the metabolic syndrome clinical criteria proposed by major organizations are similar, some of them put special emphasis on certain variables by using different cut-off values. Most organizations have criteria for obesity (mostly abdominal), insulin resistance, dyslipidemia, and blood pressure. The proposals put forward by the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III or ATP III) and the International Diabetes Federations (IDF) use virtually the same criteria and cut-off values. The exception is waist circumference, for which the IDF cut-off value is lower. The IDF has also proposed different waist circumference cut-offs for various regions of the world in order to address the question of ethnicity. In addition, the IDF makes waist circumference a mandatory criterion. To be diagnosed with the metabolic syndrome, one should have a waist circumference above the proposed IDF waist cut-off plus two other components of the metabolic syndrome. Consequently, in a given population, metabolic syndrome prevalence can be expected to be higher when IDF criteria are applied.  Moreover, since the American Association of Clinical Endocrinologists (AACE) did not propose a working definition, its criteria can hardly be tested in population studies unless investigators decide to specify their criteria/cut-offs in advance. Therefore, when comparing the criteria for the metabolic syndrome and incident cardiovascular disease (CVD) or diabetes, investigators can choose from the clinical criteria of NCEP-ATP III, IDF, World Health Organization (WHO), European Group for the Study of Insulin Resistance (EGIR), and hypertriglyceridemic waist.