Evaluating CMR

NCEP-ATP III clinical tools for diagnosing the metabolic syndrome and type 2 diabetes/CVD risk

Since the publication of NCEP-ATP III guidelines for diagnosing the metabolic syndrome, several population-based studies have examined the relationship between these criteria and the risk of developing CVD and/or type 2 diabetes. Most studies have found a positive relationship between the metabolic syndrome and CVD risk. This relationship is generally stronger when diabetes incidence is considered as an endpoint given the significant relationship between the metabolic syndrome and diabetes risk.

The Framingham Heart Offspring Study evaluated the incidence of CVD, CHD, and type 2 diabetes in individuals with the metabolic syndrome according to NCEP-ATP III clinical criteria (14). The study sample included 3,323 men and women who were followed for eight years. Age-adjusted relative risk (RR) for men with the metabolic syndrome was 2.88 (95% CI, 1.99-4.16) for incident CVD and 6.92 (95% CI, 4.47-10.81) for onset of type 2 diabetes. Age-adjusted relative CVD risk for women with the metabolic syndrome was 2.25 (95% CI, 1.31-3.88). Type 2 diabetes incidence in women with the metabolic syndrome was similar to that of men (RR=6.90, 95% CI, 4.34-10.94). Results of the Framingham Heart Offspring Study suggest that the metabolic syndrome as identified by NCEP-ATP III clinical criteria predicts CVD and CHD risk, and that the metabolic syndrome is an even stronger predictor of type 2 diabetes.

In the Atherosclerosis Risk In Communities (ARIC) study, McNeill et al. (15) sought to determine the relationship between the metabolic syndrome and relative CHD/stroke risk among 12,089 black and white middle-aged individuals over an 11 year follow-up. In men, RR for CHD was 1.46 (95% CI, 1.23-1.74) after adjusting for age, race/ARIC centre, LDL cholesterol levels, and smoking. Women had a similar RR (RR=2.05, 95% CI, 1.59-2.64). In the ARIC study, elevated blood pressure and low HDL cholesterol were the features of the metabolic syndrome with the strongest ties to CHD risk.