Comparisons of different metabolic syndrome definitions and associations with coronary heart disease, stroke, and peripheral arterial disease in a rural Chinese population.

Jiangping Wen,Xinxin Lu,Yujie Shi,Yaping Tian,Qiushan Tao,Ningli Wang,Xinrong Duan,Fenghua Wang,Jingang Yang,Yuanbo Liang,Xilin Lu,Angelo Scuteri

doi:10.1371/journal.pone.0126832

Abstract

ObjectivesWe estimated the prevalence of metabolic syndrome (MetS) and compared associations of different MetS definitions with coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD) in a rural Chinese population.MethodsAmong 4,748 residents (2,145 men and 2,603 women) aged 30+ years in rural China from 2006 to 2007, the prevalence of MetS was estimated by using five different definitions: modified World Health Organization (WHO), Chinese Diabetes Society (CDS), the updated National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) for Asian-Americans, International Diabetes Federation (IDF), and Joint Interim Statement (JIS). Multivariable logistic regression analyses were implemented to estimate the association between MetS and the prevalence of CHD, stroke and PAD, respectively.ResultsPrevalence of MetS in men was 11.5% (WHO), 14.8% (CDS), 32.4% (NCEP-ATP III), 27.5% (IDF) and 39.7% (JIS) and in women was 15.7% (WHO), 20.7% (CDS), 54.2% (NCEP-ATP III), 51.5% (IDF) and 54.2% (JIS), respectively. Respective ORs (95% CI) for associating MetS with CHD in men were 1.79 (1.02-3.17), 1.25 (0.69-2.26), 1.61 (1.01-2.58), 1.84 (1.14-2.96), and 1.53 (0.96-2.43). Corresponding ORs (95% CI) for stroke in men were 2.18 (95% CI 1.20 to 3.97), 2.20 (95% CI 1.25 to 3.89), 1.71 (95% CI 1.02 to 2.84), 1.30 (95% CI 0.77 to 2.23), and 1.61 (95% CI 0.97 to 2.68), respectively. In women, CHD and stroke were significantly associated with MetS using all five definitions of MetS. In addition, PAD was associated with all five MetS definitions in men, but not in women. Only hyperglycemia and BMI were significantly associated with PAD in women.ConclusionsIn this rural Chinese population, the JIS, IDF and CDS criteria may not be more suitable than WHO and updated NCEP-ATPIII definitions for screening high-risk individuals and estimating the risk of CHD and stroke from MetS, especially in men.

Highlights

Metabolic syndrome (MetS) is characterized by a clustering of cardiovascular risk factors, including hyperglycemia, raised blood pressure, elevated triglycerides, low high-density lipoprotein cholesterol, and obesity [1]
Hyperglycemia and Body mass index (BMI) were significantly associated with peripheral arterial disease (PAD) in women. In this rural Chinese population, the Joint Interim Statement (JIS), International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS) criteria may not be more suitable than World Health Organization (WHO) and updated National Cholesterol Education Program (NCEP)-ATPIII definitions for screening high-risk individuals and estimating the risk of coronary heart disease (CHD) and stroke from MetS, especially in men
Since Reaven first described the concept of syndrome X in 1988 [2], several MetS definitions have been proposed by different international organizations over the past decade, including the World Health Organization (WHO) [3], the National Cholesterol Education Program (NCEP) [4], the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) [5], the International Diabetes Federation (IDF) [6], and the Chinese Diabetes Society (CDS) [7]

Summary

Introduction

Metabolic syndrome (MetS) is characterized by a clustering of cardiovascular risk factors, including hyperglycemia, raised blood pressure, elevated triglycerides, low high-density lipoprotein cholesterol, and obesity ( central adiposity) [1]. Since Reaven first described the concept of syndrome X (later renamed MetS) in 1988 [2], several MetS definitions have been proposed by different international organizations over the past decade, including the World Health Organization (WHO) [3], the National Cholesterol Education Program (NCEP) [4], the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) [5], the International Diabetes Federation (IDF) [6], and the Chinese Diabetes Society (CDS) [7]. A new Joint Interim Statement (JIS) was proposed by IDF and AHA/NHLBI to harmonize the definition of MetS [1]. The IDF, NCEP, and new JIS definitions emphasize central obesity, but the WHO definition focuses on insulin resistance. Few data exist to associate different definitions of MetS with CHD, stroke, and PAD risk. Available data are conflicting [14,15,16,17,18,19]

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