Abstract
BackgroundThe additional clinical value of clustering cardiovascular risk factors to define the metabolic syndrome (MetS) is still under debate. However, it is unclear which cardiovascular risk factors tend to cluster predominately and how individual risk factor states change over time.Methods & ResultsWe used data from 3,187 individuals aged 20–79 years from the population-based Study of Health in Pomerania for a network-based approach to visualize clustered MetS risk factor states and their change over a five-year follow-up period. MetS was defined by harmonized Adult Treatment Panel III criteria, and each individual's risk factor burden was classified according to the five MetS components at baseline and follow-up. We used the map generator to depict 32 (25) different states and highlight the most important transitions between the 1,024 (322) possible states in the weighted directed network. At baseline, we found the largest fraction (19.3%) of all individuals free of any MetS risk factors and identified hypertension (15.4%) and central obesity (6.3%), as well as their combination (19.0%), as the most common MetS risk factors. Analyzing risk factor flow over the five-year follow-up, we found that most individuals remained in their risk factor state and that low high-density lipoprotein cholesterol (HDL) (6.3%) was the most prominent additional risk factor beyond hypertension and central obesity. Also among individuals without any MetS risk factor at baseline, low HDL (3.5%), hypertension (2.1%), and central obesity (1.6%) were the first risk factors to manifest during follow-up.ConclusionsWe identified hypertension and central obesity as the predominant MetS risk factor cluster and low HDL concentrations as the most prominent new onset risk factor.
Highlights
The metabolic syndrome (MetS) has gained recent attention as a multifactorial cluster of cardiovascular risk factors linked to criteria of adiposity, hypertension, dyslipidemia, and hyperglycaemia
We identified hypertension and central obesity as the predominant MetS risk factor cluster and low high-density lipoprotein cholesterol (HDL) concentrations as the most prominent new onset risk factor
We found the largest fraction (19.3% of all individuals) in the healthy state without any MetS risk factors, of which 58% remained risk factor free and 42% developed risk factors at follow-up (11.1% of all individuals were without any MetS risk factors at baseline and follow-up) (Table 2)
Summary
The metabolic syndrome (MetS) has gained recent attention as a multifactorial cluster of cardiovascular risk factors linked to criteria of adiposity, hypertension, dyslipidemia, and hyperglycaemia. With regard to cardiovascular risk, MetS was admittedly associated with accelerated central arterial ageing, but specific clusters of MetS components showed dramatically increased arterial changes [12]. These outcome associations may give a clue which risk factors drive the underlying MetS pathophysiology, investigations which MetS components tend to cluster predominately and how individual risk factor states change over time are scarce [13,14]. The additional clinical value of clustering cardiovascular risk factors to define the metabolic syndrome (MetS) is still under debate It is unclear which cardiovascular risk factors tend to cluster predominately and how individual risk factor states change over time
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