Abstract 10209: The Severity of the Metabolic Syndrome Increases over Time within Individuals, Independent of Baseline Metabolic Syndrome Status and Medication Use: The Atherosclerosis Risk in Communities Study

Abstract

Background: Clinical significance of traditional ATP-III metabolic syndrome (MetS) is a subject of debate, possibly due to its inability to track disease progression over time. We have developed a continuous MetS severity z-score such that the relative contributions of each of the MetS components to the overall severity score vary by sex- and race/ethnicity, and thus the score changes over time with MetS components. We aim to examine how MetS severity changes over time within individuals. Methods: Changes in MetS severity score were assessed over a 12-year period (Visits 1-4) among 9,291 participants of the Atherosclerosis Risk in Communities study, after excluding those with baseline MetS, CVD or diabetes. Age-adjusted rate of change in the MetS severity score and MetS prevalence as assessed using ATP-III MetS criteria were compared among sex- and racial/ethnic subgroups. Further, effects of age (<50, 50-60, and >60 years) and use of medications for hypertension, diabetes and dyslipidemia on MetS severity progression were examined. Results: MetS severity z-scores increased among 76% of participants between visits 1 and 4, with an overall increase in z-score from 0.08 (±0.77) at baseline to 0.48 (±0.96) at visit 4. The greatest progression was observed among African-American women. Baseline MetS severity z-scores predicted the time until ATP-III MetS diagnosis, with 90.2% of individuals with score of ≥1.0 (n=1,097) progressing to ATP-III MetS by visit 4. Score progression was higher among those younger (<50 years) at baseline but was independent of baseline MetS status or the use of medications to treat blood pressure, lipids and diabetes. Conclusion: The severity of metabolic derangements as measured using this sex- and race/ethnicity specific MetS z-score increases over time within individuals and predicts diagnosis of ATP-III MetS. These data may have implications for tracking MetS related risk over time within individuals.