Weight, the Metabolic Syndrome, and Coronary Heart Disease in Type 2 Diabetes: Associations Among a National French Sample of Adults With Diabetes?The ENTRED Study

Abstract

The authors examined whether obesity alone or as part of the metabolic syndrome (MS) increases coronary heart disease (CHD) risk in type 2 diabetes mellitus (T2DM) among 2970 adults aged 30-79 years in a French national sample. MS was defined as T2DM plus self-report of 2 or more of the following: body mass index >30 kg/m(2), diagnosed hypertension, or diagnosed dyslipidemia. A subsample with physician-reported data (n =841) was further classified with measured hypertension and dyslipidemia. Weight distribution included normal (21%), overweight (42%), and obese (37%). A 20% increased odds of CHD was estimated for every 5-kg/m(2) body mass index increase (P=.0001). MS was associated with a more than 2-fold higher risk of CHD compared with T2DM without MS (P<.0001, multivariate-adjusted [both samples]). With MS stratified by high-density lipoprotein cholesterol (<1.5 vs > or =1.5 mmol/L), compared with no MS, the odds ratio for CHD was 2.8 (normal-level high-density lipoprotein MS; 95% confidence interval, 1.8-4.5) and 1.5 (high-level high-density lipoprotein MS; 95% confidence interval, 0.8-2.9). The authors suggest that obesity alone--and particularly when the MS is present--increases CHD risk in patients with T2DM. High levels of high-density lipoprotein may modify this relationship.