Abstract
BackgroundIn the general population, metabolic syndrome (MetS) is predictive of major adverse cardiovascular events (MACE). Waist circumference (WC), a component of the MetS criteria, is linked to visceral obesity, which in turn is associated with MACE. However, in haemodialysis (HD) patients, the association between MetS, WC and MACE is unclear.MethodsIn a cross-sectional study of 1000 HD patients, we evaluated the prevalence and characterised the clinical predictors of MetS. The relationship between MetS and its components, alone or in combination, and MACE (coronary diseases, peripheral arteriopathy, stroke or cardiac failure), was studied using receiver operating characteristics (ROC) curves and logistic regression.ResultsA total of 753 patients were included between October 2011 and April 2013. The prevalence of MetS was 68.5%. Waist circumference (> 88 cm in women, 102 cm in men) was the best predictor of MetS (sensitivity 80.2; specificity 82.3; AUC 0.80; p < 0.05). In multivariate analysis, MetS was associated with MACE (OR: 1.85; 95CI 1.24–2.75; p < 0.01), but not WC alone. There was a stronger association between the combination of abdominal obesity, hypertriglyceridaemia and low high-density lipoprotein cholesterol with MACE after exclusion of impaired fasting glucose and hypertension.ConclusionsMetS is frequent and significantly associated with MACE in our haemodialysis cohort and probably in other European dialysis populations as well. In HD patients, a new simplified definition could be proposed in keeping with the concept of the “hypertriglyceridaemic waist”.
Highlights
In the general population, metabolic syndrome (MetS) is predictive of major adverse cardiovascular events (MACE)
We found no significant association between high waist circumference (MsWC) and history of MACE, after adjustment for diabetes and body mass index (BMI)
Our findings show that the combinations of MsWC + TG ≥1.5 g/L (MsTG) or MsWC + MsTG + MsHDL were those most significantly associated with cardiovascular complications
Summary
Metabolic syndrome (MetS) is predictive of major adverse cardiovascular events (MACE). Waist circumference (WC), a component of the MetS criteria, is linked to visceral obesity, which in turn is associated with MACE. Obesity is a significant risk factor for diabetes, high blood pressure and coronary heart disease in the general population and contributes to overall mortality worldwide. In the general population, several studies, notably the INTERHEART study, found a closer relationship between waist circumference (WC), which refers to abdominal obesity, and cardiovascular mortality, comparatively to BMI. In the NHANES III study, WC was an independent predictor of cardiovascular mortality [7] In another study, it was the single parameter explaining the relationship between obesity and cardiovascular morbidity [8]
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