Estimation of the proportion of metabolic syndrome-free subjects on high cardiometabolic risk using two continuous cardiometabolic risk scores: a cross-sectional study in 16- to 20-year-old individuals

Abstract

In contrast to the dichotomous classification of metabolic syndrome, continuous metabolic syndrome scores enable to assess cardiometabolic burden in metabolic syndrome-free individuals. Using receiver operating characteristics analysis, discrimination power of continuous metabolic syndrome score calculated from population-based Z-scores or individual measures corrected to the accepted international standards for presence/absence of metabolic syndrome was assessed. Calculated cutoff values were used to estimate the proportions of metabolic syndrome-free subjects presenting high cardiometabolic risk. Clinical data were collected from 2331 (52% females) 16- to 20-year-old subjects. Receiver operating characteristics analyses showed an acceptable performance of both scores to classify metabolic syndrome presence: area under the curve (97-98%), sensitivity (95-100%), and specificity (86-96%). Compared with the prevalence of metabolic syndrome, proportions of metabolic syndrome-free subjects on high cardiometabolic risk, e.g., presenting continuous scores ≥ cutoff points, were about 3-fold higher in males, and 4-fold higher in females. Both scores correlated significantly with markers of cardiometabolic risk.Conclusion: Continuous cardiometabolic syndrome scores are practical tools to evaluate cardiometabolic risk in subjects not presenting metabolic syndrome. Accuracy, simplicity, and ability to classify metabolic syndrome-free subjects on high cardiometabolic risk make continuous metabolic syndrome score derived from international standards convenient for use in research and clinical practice. What is Known: • Dichotomous classification of metabolic syndrome is simple but not suitable for assessment of cardiometabolic burden in metabolic syndrome-free subjects. This prompted implementation of continuous scores, which are generally sample-specific. Score based on internationally accepted standards allows for comparison between populations and studies. • The performance of different continuous metabolic syndrome scores to assess the prevalence of metabolic syndrome-free subjects presenting high cardiometabolic burden has not been compared yet. What is New: • We compared the discrimination power of sample-specific Z-score-derived continuous metabolic syndrome score and that calculated based on internationally accepted standards for presence or absence of metabolic syndrome in young subjects. • The prevalence of metabolic syndrome-free subjects presenting high cardiometabolic risk was estimated using the cutoff points of continuous metabolic syndrome scores derived from the analyses of receiver operating characteristic curves.