Evaluating CMR

IDF clinical tools for diagnosing the metabolic syndrome and type 2 diabetes/CVD risk

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After adjusting for confounding variables, the best predictors of incident CHD in this diabetic population were systolic blood pressure and HDL cholesterol levels.

During the 10 year follow-up of the Strong Heart Study, 1,561 men and 2,384 women with and without diabetes were screened for the presence of the metabolic syndrome using a number screening tools (21). With the IDF criteria, metabolic syndrome prevalence at the beginning of follow-up was 59% and 73% for men and women, respectively. After adjusting for age, sex, and field centre, non-diabetic subjects who met IDF clinical criteria for the metabolic syndrome had a HR for incident fatal or non-fatal CVD of 1.42 (95% CI, 1.22-1.66, p<0.001). For subjects with diabetes, the HR for incident CVD was 2.59 (95% CI, 2.25-2.98, p<0.001).

To assess CHD risk related to the metabolic syndrome, Bataille et al. (22) conducted a nested case-control study in the PRIME (étude PRospective de l’Infarctus du MyocardE-Prospective Epidemiological Study of Myocardial Infarction) cohort. The PRIME study was conducted in Northern Ireland (Belfast) and France, particularly in Lille (North), Strasbourg (East), and Toulouse (Southwest). The study sample included 296 cases of incident CHD and 540 CHD-free controls, all of whom were men 50 to 59 years of age. The study follow-up was five years. When IDF clinical criteria for the metabolic syndrome were used, the metabolic syndrome was prevalent in 38.9% of cases and 32.4% of controls. When the data was analyzed separately (Ireland and France), the odds ratio (OR) for future CHD was not significant. However, when the entire sample was studied, the future CHD OR for individuals with IDF clinical criteria for the metabolic syndrome was 1.41 (95% CI, 1.02-1.95, p<0.04). The findings were very similar when the WHO and NCEP-ATP III clinical criteria were compared.

Reference

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21. de Simone G, Devereux RB, Chinali M, et al. Prognostic impact of metabolic syndrome by different definitions in a population with high prevalence of obesity and diabetes: the Strong Heart Study. Diabetes Care 2007; 30: 1851-6.

22. Bataille V, Perret B, Dallongeville J, et al. Metabolic syndrome and coronary heart disease risk in a population-based study of middle-aged men from France and Northern Ireland. A nested case-control study from the PRIME cohort. Diabetes Metab 2006; 32: 475-9.

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