Abstract
BackgroundThe severity of the metabolic syndrome (MetS) is significantly associated with future coronary heart disease (CHD) among individuals without baseline Type 2 diabetes. However, the validity of assessing MetS severity among individuals with diabetes is unknown.ObjectiveTo assess for differences in MetS severity by timing of Type 2 diabetes diagnosis and to assess for associations between MetS severity and future CHD among individuals with diabetes.MethodsWe analyzed data from participants of the Atherosclerosis Risk in Communities study, including 1419 with- and 7241 without diabetes, followed during 4 visits and adjudicated CHD diagnoses over a 20-year period. We used Cox-regression techniques to assess hazard ratios (HR) of CHD based on a sex- and race/ethnicity-specific MetS-severity Z-score (standard MetS score) and a similar MetS-severity score formulated without incorporating glucose as a component of MetS (no-glucose MetS score).ResultsFor both the standard- and no-glucose MetS-severity scores, scores were highest in the baseline-diabetes group, lowest in the never-diabetes group and intermediate in the incident-diabetes groups. Among participants with diabetes, increasing MetS-severity score at baseline was associated with incident CHD, using both the standard MetS score (HR 1.29, 95% confidence interval [CI] 1.21, 1.39) and the no-glucose score (HR 1.42, CI 1.24, 1.62) (both p < 0.001). For the baseline-diabetes group, this relationship remained significant when Visit 2 Hemoglobin-A1c was included in the model, both for the standard MetS score (HR 1.21, CI 1.09, 1.34; p < 0.001) and the no-glucose score (HR 1.25, CI 1.04, 1.51; p = 0.02).ConclusionsMetS severity appears to provide an estimate of metabolic disarray in the setting of diabetes and is predictive of future CHD events beyond HbA1c. Identifying MetS severity among individuals with diabetes may help in identifying those at higher risk, who could then receive further preventative treatment.
Highlights
Cardiovascular disease (CVD) remains the leading cause of mortality among patients with Type 2 diabetes mellitus (T2DM), continuing the need for predictive tools to identify those at highest risk [1]
metabolic syndrome (MetS) severity appears to provide an estimate of metabolic disarray in the setting of diabetes and is predictive of future coronary heart disease (CHD) events beyond HbA1c
We found that a continuous estimate of MetS severity retained the ability to predict CHD risk among individuals with Type 2 diabetes
Summary
Cardiovascular disease (CVD) remains the leading cause of mortality among patients with Type 2 diabetes mellitus (T2DM), continuing the need for predictive tools to identify those at highest risk [1]. Gurka et al Cardiovasc Diabetol (2018) 17:17 have been limited by their binary nature and by racial/ ethnic discrepancies, underestimating risk among African Americans [15,16,17,18] For these reasons we formulated a MetS-severity Z score that serves as a continuous estimate of metabolic derangement [19, 20]. We developed a MetSseverity score that does not include glucose as a component and demonstrated that this no-glucose MetS score retained the ability to predict future diabetes [23] These MetS-severity scores were derived and have been assessed only in populations without baseline diabetes. The severity of the metabolic syndrome (MetS) is significantly associated with future coronary heart disease (CHD) among individuals without baseline Type 2 diabetes. The validity of assessing MetS severity among individuals with diabetes is unknown
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