By Thomas S. May
HELSINKI, FINLAND -- June 13, 2007 -- Subjects with the metabolic syndrome (MS) have an elevated risk of cardiovascular disease (CVD), even if they have normal fasting glucose levels, according to a 15-year prospective study, which was presented here at the 76th Congress of the European Atherosclerosis Society (EAS).
MS has been defined differently by different organizations. According to the Adult Treatment Panel (ATP) of the National Cholesterol Education Program (NCEP), for example, one only needs to have three of the following five characteristics to be diagnosed with MS: elevated fasting blood glucose, large waist circumference, high triglycerides, low high-density lipoprotein cholesterol (HDL-C), and high blood pressure (BP).
For the World Health Organization (WHO), definition, however, one has to have diabetes or impaired fasting glucose (IFG), in addition to high waist-hip ratio, high triglycerides, low HDL-C, and high BP, to be diagnosed with MS, and the International Diabetes Federation (IDF) criteria also include diabetes or IFG in the definition of MS.
To evaluate the CV risk attributable to MS, and to determine the importance of IFG in this regard, a team of Italian researchers conducted a 15-year long, prospective study of a Sicilian population. 687 subjects between 35-75 years of age were followed for 15 years, whereby, the presence of MS, as well as total and cardiovascular mortality, and all CV events were recorded. MS was defined according to both the ATP-III and the IDF criteria.
An analysis of the results revealed that MS significantly increased the risk of CV events, (HR = 1.9, CI 1.46-2.46). Using a Cox proportional hazards estimation model, the survival curve of subjects with MS and IFG did not differ significantly from that of subjects with MS and normal fasting glucose.
These data show that MS predicts CV events in subjects with or without IFG, according to lead investigator Carlo Barbagallo, MD, assistant professor of internal medicine, Department of Clinical Medicine and Emerging Diseases, University of Palermo School of Medicine, Palermo, Italy. "So the metabolic syndrome is an important CV risk factor, independent of fasting glucose levels," said Dr. Barbagallo.
The results also suggest that the ATP-III definition of MS is more predictive of CV events than the IDF classification, Dr. Barbagallo noted, since the latter would consider subjects with MS (according to the ATP-III definition) but normal fasting glucose to be at low risk for CV events (7-8% in 10 years), when in fact these subjects have a significantly increased (approximately two-fold) risk of CV events in 10 years.
[Presentation title: The Metabolic Syndrome Predicts Cardiovascular Events in Subjects with Normal Fasting Glucose. A Fifteen Years Follow-Up in a Mediterranean Population. Abstract P677]
E-Mail this DGDispatch to a colleague
