Top

Published in:

Open Access 01-12-2015 | Research article

Does the impact of metabolic syndrome on cardiovascular events vary by using different definitions?

Authors: Hossein Khosravi-Boroujeni, Faruk Ahmed, Masoumeh Sadeghi, Hamidreza Roohafza, Mohammad Talaei, Minoo Dianatkhah, Ali Pourmogaddas, Nizal Sarrafzadegan

Published in: BMC Public Health | Issue 1/2015

Abstract

Background

Metabolic Syndrome (MetS) is a complex disorder which increases the risk of chronic diseases, including cardiovascular diseases and diabetes mellitus. As a result of modern lifestyles, the prevalence of MetS has been rising globally. This study aims to investigate whether overall prevalence of MetS varies when using different definitions of MetS and to identify the best and most predictive definition of the MetS for cardiovascular disease (CVD) events over 10 years in a cohort of an Iranian population.

Method

Adults aged ≥ 35 years from urban and rural regions in central Iran were selected at baseline and followed up for more than 10 years. Data on socio-demographic characteristics, anthropometry, blood pressure and smoking status were collected at baseline. In addition, various biochemical indices were assessed. MetS was defined based on five available definitions, and cardiovascular events during 10 years follow up were confirmed by an expert group. The hazard ratios were calculated by the Cox proportional hazards model.

Results

The highest prevalence of MetS was observed by using AHA-NHBI definition (36.9 %), followed by JIS definition (31.2 %). On the other hand, EGIR (8.8 %) provided the lowest prevalence. The risk of developing CVD, irrespective of definitions, was approximately two fold higher in the presence of MetS. After controlling for possible confounders, AHA-NHBI definition was found to be the best predictor of CVD.

Conclusion

This study demonstrated a great variability in the prevalence of MetS among Iranian adults when using different definitions of MetS. CVD risk was significantly higher in MetS participants, as well as in participants with any risk factors of MetS; however, the AHA-NHBI definition was found to be the best predictor of CVD. Thus protective measures, including lifestyle modifications, plus control of individual risk factors is necessary to prevent cardiovascular events.

Panel NCEPNE. Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation. 2002;106(25):3143–421.

Browning JD, Szczepaniak LS, Dobbins R, Horton JD, Cohen JC, Grundy SM, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40(6):1387–95.PubMedCrossRef

Chen L-Y, Qiao Q-H, Zhang S-C, Chen Y-H, Chao G-Q, Fang L-Z. Metabolic syndrome and gallstone disease. World J Gastroenterol. 2012;18(31):4215–20.PubMedPubMedCentralCrossRef

Lim S, Davies M, Norman R, Moran L. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(6):618–37.PubMedCrossRef

Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J. 2004;25(9):735–41.PubMedCrossRef

Malik S, Wong ND, Franklin SS, Kamath TV, Gilbert J, Pio JR, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004;110(10):1245–50.PubMedCrossRef

van Vliet-Ostaptchouk JV, Nuotio M-L, Slagter SN, Doiron D, Fischer K, Foco L, et al. The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies. BMC Endocr Disord. 2014;14(1):9.PubMedPubMedCentralCrossRef

Sarrafzadegan N, Kelishadi R, Esmaillzadeh A, Mohammadifard N, Rabiei K, Roohafza H, et al. Do lifestyle interventions work in developing countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran. Bull World Health Organ. 2009;87(1):39–50.PubMedPubMedCentralCrossRef

Delavari A, Forouzanfar MH, Alikhani S, Sharifian A, Kelishadi R. First nationwide study of the prevalence of the metabolic syndrome and optimal cutoff points of waist circumference in the Middle East the national survey of risk factors for noncommunicable diseases of Iran. Diabetes Care. 2009;32(6):1092–7.PubMedPubMedCentralCrossRef

10.

Nizal Sarrafzadegan M, Sadeghi M, Shahram Oveisgharan M, Marshall T. Incidence of cardiovascular diseases in an Iranian population: the Isfahan Cohort Study. Arch Iran Med. 2013;16(3):138–44.PubMed

11.

Alberti K, Eckel R, Grundy S, Zimmet P, Cleeman J, Donato K, et al. International diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; international association for the study of obesity. harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; american heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation. 2009;120(16):1640–5.PubMedCrossRef

12.

World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation, vol. 1. Geneva: World Health Organization; 1999.

13.

International Diabetes Federation: The IDF consensus worldwide definition of the metabolic syndrome. Brussels, Belgium: IDF Communications; 2006. http://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf.

14.

Expert Panel on Detection E, Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285(19):2486–97.CrossRef

15.

Brown TM, Vaidya D, Rogers WJ, Waters DD, Howard BV, Tardif J-C, et al. Does prevalence of the metabolic syndrome in women with coronary artery disease differ by the ATP III and IDF criteria? J Womens Health. 2008;17(5):841–7.CrossRef

16.

Sarrafzadegan N, Talaei M, Sadeghi M, Kelishadi R, Oveisgharan S, Mohammadifard N, et al. The Isfahan cohort study: Rationale, methods and main findings. J Hum Hypertens. 2010;25(9):545–53.PubMedCrossRef

17.

McNamara JR, Schaefer EJ. Automated enzymatic standardized lipid analyses for plasma and lipoprotein fractions. Clin Chem Acta. 1987;166(1):1–8.CrossRef

18.

Warnick G, Nguyen T, Albers A. Comparison of improved precipitation methods for quantification of high-density lipoprotein cholesterol. Clin Chem. 1985;31(2):217–22.PubMed

19.

Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.PubMed

20.

Balkau B, Charles M-A. Comment on the provisional report from the WHO consultation. Diabet Med. 1999;16(5):442–3.PubMedCrossRef

21.

Alberti K, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A consensus statement from the international diabetes federation. Diabet Med. 2006;23(5):469–80.PubMedCrossRef

22.

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome an American heart association/national heart, lung, and blood institute scientific statement. Circulation. 2005;112(17):2735–52.PubMedCrossRef

23.

He Y, Jiang B, Wang J, Feng K, Chang Q, Fan L, et al. Prevalence of the metabolic syndrome and its relation to cardiovascular disease in an elderly Chinese population. J Am Coll Cardiol. 2006;47(8):1588–94.PubMedCrossRef

24.

Reaven G. The metabolic syndrome or the insulin resistance syndrome? Different names, different concepts, and different goals. Endocrinol Metab Clin North Am. 2004;33(2):283–303.PubMedCrossRef

25.

Eckel R, Yost T, Jensen D. Alterations in lipoprotein lipase in insulin resistance. Int J Obes Relat Metab Disord. 1995;19:S16–21.PubMed

26.

Ferrannini E, Buzzigoli G, Bonadonna R, Giorico MA, Oleggini M, Graziadei L, et al. Insulin resistance in essential hypertension. N Engl J Med. 1987;317(6):350–7.PubMedCrossRef

27.

Carr DB, Utzschneider KM, Hull RL, Kodama K, Retzlaff BM, Brunzell JD, et al. Intra-abdominal fat is a major determinant of the national cholesterol education program adult treatment panel III criteria for the metabolic syndrome. Diabetes. 2004;53(8):2087–94.PubMedCrossRef

28.

Hayashi T, Boyko EJ, Leonetti DL, McNeely MJ, Newell-Morris L, Kahn SE, et al. Visceral adiposity and the risk of impaired glucose tolerance a prospective study among Japanese Americans. Diabetes Care. 2003;26(3):650–5.PubMedCrossRef

29.

Rattarasarn C, Leelawattana R, Soonthornpun S, Setasuban W, Thamprasit A, Lim A, et al. Regional abdominal fat distribution in lean and obese Thai type 2 diabetic women: relationships with insulin sensitivity and cardiovascular risk factors. Metabolism. 2003;52(11):1444–7.PubMedCrossRef

30.

Nicklas BJ, Penninx BW, Ryan AS, Berman DM, Lynch NA, Dennis KE. Visceral adipose tissue cutoffs associated with metabolic risk factors for coronary heart disease in women. Diabetes Care. 2003;26(5):1413–20.PubMedCrossRef

31.

Lamarche B, Lemieux S, Dagenais G, Després J-P. Visceral obesity and the risk of ischaemic heart disease: insights from the Quebec Cardiovascular Study. Growth Horm IGF Res. 1998;8:1–8.PubMedCrossRef

32.

van Harmelen V, Dicker A, Rydén M, Hauner H, Lönnqvist F, Näslund E, et al. Increased lipolysis and decreased leptin production by human omental as compared with subcutaneous preadipocytes. Diabetes. 2002;51(7):2029–36.PubMedCrossRef

33.

Yatagai T, Nagasaka S, Taniguchi A, Fukushima M, Nakamura T, Kuroe A, et al. Hypoadiponectinemia is associated with visceral fat accumulation and insulin resistance in Japanese men with type 2 diabetes mellitus. Metabolism. 2003;52(10):1274–8.PubMedCrossRef

34.

Abate N, Chandalia M, Snell PG, Grundy SM. Adipose tissue metabolites and insulin resistance in nondiabetic Asian Indian men. J Clin Endocrinol Metab. 2004;89(6):2750–5.PubMedCrossRef

35.

Tan C-E, Ma S, Wai D, Chew S-K, Tai E-S. Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians? Diabetes Care. 2004;27(5):1182–6.PubMedCrossRef

36.

Fereidoun Azizi M, Davood Khalili M, Hassan Aghajani M, Alireza Esteghamati M, Farhad Hosseinpanah M, Alireza Delavari M, et al. Appropriate waist circumference cut-off points among Iranian adults: the first report of the Iranian National Committee of Obesity. Arch Iran Med. 2010;13(3):243.PubMed

37.

Zabetian A, Hadaegh F, Azizi F. Prevalence of metabolic syndrome in Iranian adult population, concordance between the IDF with the ATPIII and the WHO definitions. Diabetes Res Clin Pract. 2007;77(2):251–7.PubMedCrossRef

38.

Azizi F, Salehi P, Etemadi A, Zahedi-Asl S. Prevalence of metabolic syndrome in an urban population: Tehran Lipid and Glucose Study. Diabetes Res Clin Pract. 2003;61(1):29–37.PubMedCrossRef

39.

Sarrafzadegan N, Kelishadi R, Baghaei A, Sadri GH, Malekafzali H, Mohammadifard N, et al. Metabolic syndrome: an emerging public health problem in Iranian women: Isfahan Healthy Heart Program. Int J Cardiol. 2008;131(1):90–6.PubMedCrossRef

40.

Cameron AJ, Magliano DJ, Zimmet PZ, Welborn T, Shaw JE. The metabolic syndrome in Australia: prevalence using four definitions. Diabetes Res Clin Pract. 2007;77(3):471–8.PubMedCrossRef

41.

Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24(4):683–9.PubMedCrossRef

42.

Girman CJ, Rhodes T, Mercuri M, Pyörälä K, Kjekshus J, Pedersen TR, et al. The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas coronary atherosclerosis prevention study (AFCAPS/TexCAPS). Am J Cardiol. 2004;93(2):136–41.PubMedCrossRef

43.

Olijhoek JK, van der Graaf Y, Banga J-D, Algra A, Rabelink TJ, Visseren FL. The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm. Eur Heart J. 2004;25(4):342–8.PubMedCrossRef

44.

Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56(14):1113–32.PubMedCrossRef

45.

Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, et al. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49(4):403–14.PubMedCrossRef

46.

Galassi A, Reynolds K, He J. Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med. 2006;119(10):812–9.PubMedCrossRef

47.

Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Meigs JB, et al. Population-based incidence rates and risk factors for type 2 diabetes in White individuals The Bruneck Study. Diabetes. 2004;53(7):1782–9.PubMedCrossRef

48.

Huang PL. A comprehensive definition for metabolic syndrome. Dis Mode Mech. 2009;2(5–6):231–7.CrossRef

49.

Stumvoll M, Mitrakou A, Pimenta W, Jenssen T, Yki-Järvinen H, Van Haeften T, et al. Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity. Diabetes Care. 2000;23(3):295–301.PubMedCrossRef

Title: Does the impact of metabolic syndrome on cardiovascular events vary by using different definitions?
Authors: Hossein Khosravi-Boroujeni
Faruk Ahmed
Masoumeh Sadeghi
Hamidreza Roohafza
Mohammad Talaei
Minoo Dianatkhah
Ali Pourmogaddas
Nizal Sarrafzadegan
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-015-2623-3

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Does the impact of metabolic syndrome on cardiovascular events vary by using different definitions?

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2015

Current state and trends of access to sanitation in Ethiopia and the need to revise indicators to monitor progress in the Post-2015 era

A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools

Comparing databases: determinants of sexually transmitted infections, HIV diagnoses, and lack of HIV testing among men who have sex with men

An evaluation of China’s new rural cooperative medical system: achievements and inadequacies from policy goals

Individual socio-demographic factors and perceptions of the environment as determinants of inequalities in adolescent physical and psychological health: the Olympic Regeneration in East London (ORiEL) study

The ring plus project: safety and acceptability of vaginal rings that protect women from unintended pregnancy