Abstract
BackgroundBased on the AHA/NHLBI-definition three out of five cardiometabolic traits must be present for the diagnosis of the metabolic syndrome (MetS), resulting in 16 different combination types. The associated cardiovascular risk may however be different and specific combination may be indicative of an increased risk, furthermore little is known to which extent these 16 combinations contribute to the overall prevalence of MetS. Here we assessed the prevalence of all 16 combination types of MetS, analyzed the impact of age and gender on prevalence rates, and estimated the 10-year risk of fatal and non-fatal myocardial infarction (MI) of each MetS combination type.MethodsWe used data of the German Metabolic and Cardiovascular Risk Project (GEMCAS), a cross-sectional study, performed during October 2005, including 35,869 participants (aged 18-99 years, 61% women). Age-standardized prevalence and 10-year PROCAM and ESC risk scores for MI were calculated.ResultsIn both men and women the combination with elevated waist-circumference, blood pressure and glucose (WC-BP-GL) was the most frequent combination (28%), however a distinct unequal distribution was observed regarding age and sex. Any combination with GL was common in the elderly, whereas any combination with dyslipidemia and without GL was frequent in the younger. Men without MetS had an estimated mean 10-year risk of 4.7% (95%-CI: 4.5%-4.8%) for MI (PROCAM), whereas the mean 10-year risk of men with MetS was clearly higher (age-standardized 7.9%; 7.8-8.0%). In women without MetS the mean 10-year risk for MI was 1.1%, in those with MetS 2.3%. The highest impact on an estimated 10-year risk for MI (PROCAM) was observed with TG-HDL-GL-BP in both sexes (men 14.7%, women 3.9%). However, we could identify combinations with equal risks of non-fatal and fatal MI compared to participants without MetS.ConclusionsWe observed large variations in the prevalence of all 16 combination types and their association to cardiovascular risk. The importance of different combinations of MetS changes with age and between genders putting emphasis on a tailored approach towards very young or very old subjects. This knowledge may guide clinicians to effectively screen individuals and prioritize diagnostic procedures depending on age and gender.
Highlights
Based on the AHA/NHLBI-definition three out of five cardiometabolic traits must be present for the diagnosis of the metabolic syndrome (MetS), resulting in 16 different combination types
Compared to the mean 10-year risk of all women with MetS, we observed three combinations with lower 10-years risk estimates (Figure 3), all including elevated waist circumference (WC-HDL-GL, WC-BP-GL, WCTG-BP), but - different to men - we found one combination with elevated blood pressure
The results of our study show a large variation of the 16 possible combinations with WC-BP-GL as the most frequent combination
Summary
Based on the AHA/NHLBI-definition three out of five cardiometabolic traits must be present for the diagnosis of the metabolic syndrome (MetS), resulting in 16 different combination types. According lipoprotein cholesterol (HDL) and (5) elevated blood pressure (BP) This definition allows 16 possible combinations for a diagnosis of MetS. One of the criticisms refers to underlying implicit assumption that each combination type of the MetS uniformly increases risk for cardiovascular outcomes. Numerous studies addressed partly this issue by investigating the effect of the number of MetS-defining traits. These studies show a gradual increase in risk of cardiovascular outcomes with numerically increasing traits [11,12]. Previous studies reported a progressive increase for cardiovascular outcomes in those individuals diagnosed with MetS consisting of 5 traits compared to those diagnosed with MetS consisting of only 3 traits [13,14,15,16,17]
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