Reuters Health Information (2005-08-29): Altering metabolic syndrome criteria may be clinically useful
Altering metabolic syndrome criteria may be clinically useful
Last Updated: 2005-08-29 14:30:14 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Using alternative metabolic
syndrome criteria yields cardiovascular risk estimates comparable to
those derived by using the National Cholesterol Education Program Adult
Treatment Panel 3 (NCEP) criteria, according to results of a study
published in the September issue of the American Journal of
Epidemiology. However, evaluating risk on more of a continuum may allow
consideration of alternative definitions by gender or for patients with
other risk factors.
"Studies have shown an increased risk of cardiovascular outcomes
with the metabolic syndrome, but information on predictive properties
of the NCEP criteria is sparse," Dr. Cynthia J. Girman, of Merck
Research Laboratories, West Point, Pennsylvania, and colleagues write.
Using data from the Hoorn population-based study in the Netherlands,
the researchers examined the effect of varying cutpoints for the NCEP
metabolic syndrome components and their association with cardiovascular
morbidity and mortality. They used classification tree, survival tree,
and hierarchical and nonparametric clustering techniques. In addition,
the team assessed alternative approaches that may better characterize
risk as a continuum.
Included in the study were 2484 subjects between the ages of 50 and
75 years. The participants were examined in 1989 and followed for
cardiovascular morbidity and mortality through 2000 to assess NCEP
criteria. Cluster analyses were used to assess whether NCEP identifies
a mixture of heterogeneous groups.
Participants of each gender who met NCEP criteria appeared to be
divided into clusters distinguished mainly by triglycerides or
high-density lipoprotein cholesterol. When individual metabolic
syndrome components were used separately, cutpoints of those predicting
cardiovascular events using regression tree techniques varied by gender
and endpoint. However, Cox model hazards were generally comparable to
the NCEP criteria regardless of cutpoints (range 1.3 to 2.5).
Increasing numbers of components were associated with a clear
gradation in risk of cardiovascular outcomes. This elevation in risk
differed by gender, with statistically elevated risk for three or more
NCEP components in men and for two or more components in women.
"Hence, using the number of components to reflect a gradation in
risk may be more useful for clinicians in evaluating patients and
considering therapeutic alternatives and lifestyle changes, as
previously suggested, and may allow different criteria to be applied
for women or patients with other risk factors, if warranted," Dr.
Girman's team concludes.
Am J Epidemiol 2005;162:438-447.