1534-P: Relationship between Metabolic Syndrome Score and Insulin Resistance

Abstract

Metabolic syndrome (MS) identifies previously unrecognized individuals at risk for diabetes and cardiovascular disease. Although MS is defined as requiring ≥3 of 5 categorical factors, a continuous MS score (using race/ethnicity modified Z-scores) has been proposed to better predict outcomes and track changes with interventions. As insulin resistance (IR) may link the 5 MS factors and their risk to outcomes, we hypothesized that MS score may reflect IR and its change with different therapies. We therefore determined MS score and IR by steady-state plasma glucose (SSPG) during the Insulin Suppression Test in persons without diabetes at baseline (n=611) and before and after 3 interventions: weight loss (WL; n=29), pioglitazone (PIO; n=32), and atorvastatin (ATR; n=36). Baseline MS score correlated (r value) with SSPG (0.58), similar to the correlations of BMI with SSPG (0.54) and MS score (0.55). MS score and SSPG, respectively, correlated with HDL-C (-0.63 vs. -0.33), triglycerides (TG; 0.82 vs. 0.38), systolic BP (0.38 vs. 0.22), fasting glucose (0.46 vs. 0.38), and TG/HDL-C ratio (0.87 vs. 0.42); P<0.01 for all. After WL and PIO, SSPG and MS score decreased (P<0.05). In contrast, after ATR, SSPG increased (P<0.05), but MS score decreased (P<0.01). The change (Δ) in MS score did not correlate with ΔSSPG in any of the groups, but strongly correlated with ΔTG/HDL-C ratio: WL (r=0.94), PIO (r=0.92), and ATR (r=0.79). In conclusion, MS score correlates modestly with SSPG, but strongly with TG and TG/HDL-C ratio. Changes in MS score in response to IR-modifying therapies do not appear to reflect changes in IR but rather changes in TG. This may limit use of MS score to evaluate change in IR or disease risk. Disclosure F. Abbasi: None. P. Reaven: Advisory Panel; Self; Boston Heart Diagnostics. Research Support; Self; AstraZeneca, Novo Nordisk Inc. J. Knowles: None. Funding Doris Duke Charitable Foundation