Abstract
(1) Background: To assess the suitability of replacing conventional markers used for insulin resistance and dysglycemia by HbA1c in both the quantitative and qualitative metabolic syndrome (MetS) definition criteria; (2) Methods: Confirmatory factorial analysis was used to compare three quantitative definitions of MetS that consisted of many single-factor models, one of which included HbA1c as the dysglycemia indicator. After that, the model with the better goodness-of-fit was selected. Furthermore, a new MetS qualitative definition was proposed by replacing fasting plasma glucose with HbA1c > 5.7% in the International Diabetes Federation (IDF) definition. The clinical performance of these two MetS criteria (IDF and IDF-modified including HbA1c as the dysglycemia indicator) to predict vascular damage (pulse wave velocity [PWv], intima media thickness [IMT] and albumin-to-creatinine ratio [ACR]) was estimated; (3) Results: The single-factor model including HbA1c showed the better goodness-of-fit (χ2 = 2.45, df = 2, p = 0.293, CFI = 0.999, SRMR = 0.010). Additionally, the IDF-modified criteria gained in clinical performance to predict vascular damage (diagnostic Odds Ratio: 6.94, 1.34 and 1.90) for pulse wave velocity (PWv), intima media thickness (IMT) and albumin-to-creatinine ratio (ACR), respectively; and (4) Conclusions: These data suggest that HbA1c could be considered as a useful component to be included in the MetS definition.
Highlights
As conceptualized by several expert committees, metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors that includes central obesity, dyslipidemia, insulin resistance, dysglycemia and elevated blood pressure [1,2]
This study proposes new MetS definition criteria that replace fasting plasma glucose (FPG) with hemoglobin A1c (HbA1c) as the dysglycemic marker in the traditional International Diabetes Federation (IDF) criteria, which improves the accuracy for correctly classifying patients according to their vascular damage
Insulin resistance was placed for a long time in the cluster of risk factors for cardiovascular events and diabetes that make up MetS, the pathogenic mechanisms that support this hypothesis are far from being clarified
Summary
As conceptualized by several expert committees, metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors that includes central obesity, dyslipidemia, insulin resistance, dysglycemia and elevated blood pressure [1,2]. Previous evidence has clearly demonstrated that the presence of MetS almost doubles the risk of cardiovascular disease mortality, myocardial infarction and stroke, and increases the risk of all-cause mortality by 1.6 times [3]. A criticism for the usefulness of the MetS diagnosis is that it fails to predict cardiovascular risk better than the sum of individual components [4]. From clinical and research settings it has been suggested that there is a need to include continuous variables in the definition of MetS [5]. The use of a single indicator MetS score calculated from the continuous key variables has some advantages, for research.
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