The Metabolic Syndrome as a Clinical Tool for the Primary Care Physician
Abstract Number: 1006-P
Authors: CARLOS LORENZO, KEN WILLIAMS, KELLY J. HUNT, STEVEN M. HAFFNER
Institutions: San Antonio, TX
Results: The metabolic syndrome (MetS) predicts type 2 diabetes (T2D) and cardiovascular disease (CVD), but its clinical significance is not well established. We used the revised MetS definition of the National Cholesterol Education Program-Adult Treatment Panel III. In this definition, the cut off point of fasting plasma glucose was ≥100 mg/dL. We examined a 7.5-year incident T2D and CVD in the San Antonio Heart Study (n = 2854; age range 25-64 years).
Age- and sex-adjusted incident T2D was high in participants with fasting glucose ≥100 mg/dL (yes vs. no): in non-Hispanic whites, 23.5 vs. 3.1% (p <0.001); in Mexican Americans, 32.7 vs. 7.1% (p <0.001). Among subjects with fasting glucose <100 mg/dL, age- and sex-adjusted incident T2D was also high in those with the MetS (yes vs. no): in non-Hispanic whites, 16.2 vs. 2.2% (p <0.001); in Mexican Americans, 21.2 vs. 5.7% (p <0.001). Among subjects with neither fasting glucose ≥100 mg/dL nor the MetS, a moderate risk still was present in those with high waist circumference (yes vs. no): in non-Hispanic whites, 6.0 vs. 1.1% (p = 0.006); in Mexican Americans, 9.3 vs. 4.3% (p = 0.008).
Age and sex-adjusted incident CVD was high in subjects with baseline CVD (yes vs. no), 17.4 vs. 2.5% (p <0.001), and in those without CVD but with T2D (yes vs. no), 5.1 vs. 1.9% (p <0.001). Among subjects with neither CVD nor T2D, CVD risk was also associated with the MetS (yes vs. no), 3.7 vs. 1.6% (p <0.001). In these individuals, the association was present in men, 6.5 vs. 2.1% (p <0.001), despite adjustment for age, total cholesterol, and current smoking; but it was not present in women, 1.9 vs. 1.6% (p = 0.200). Differences remained relevant in subjects aged 45 or older: in men 21.2 vs. 6.7% (p <0.001); in women 6.1 vs. 3.5% (p = 0.143).
In summary, the MetS can be used to detect subjects that are at increased risk for T2D. However, a moderate risk still is present in those without the MetS but with high waist circumference. In the absence of CVD and T2D, the MetS identifies men that are at increased risk for CVD.