Journal Article

An Exploratory Analysis of Criteria for the Metabolic Syndrome and Its Prediction of Long-term Cardiovascular Outcomes

Cynthia J. Girman, Jacqueline M. Dekker, Thomas Rhodes, Giel Nijpels, Coen D. A. Stehouwer, Lex M. Bouter and Robert J. Heine

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 162, issue 5, pages 438-447
Published in print September 2005 | ISSN: 0002-9262
Published online September 2005 | e-ISSN: 1476-6256 | DOI: http://dx.doi.org/10.1093/aje/kwi229
An Exploratory Analysis of Criteria for the Metabolic Syndrome and Its Prediction of Long-term Cardiovascular Outcomes

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Studies have shown an increased risk of cardiovascular outcomes with the metabolic syndrome, but information on predictive properties of the National Cholesterol Education Program Adult Treatment Panel 3 (NCEP) criteria is sparse. The authors used data from the Hoorn population-based study in the Netherlands including 2,484 participants aged 50–75 years examined in 1989 and followed for cardiovascular morbidity and mortality through 2000 to assess NCEP criteria, excluding known diabetes or cardiovascular disease. Cluster analyses explored whether NCEP identifies a mixture of heterogeneous groups. For each gender, participants meeting NCEP criteria seemed to be divided into clusters distinguished primarily by triglycerides or high density lipoprotein cholesterol. Cutpoints for components predicting cardiovascular events using classification and survival tree methodology varied by endpoint and gender, but Cox model hazards ratios were relatively comparable regardless of cutpoints (range: 1.3–2.5). Clear gradation in risk of cardiovascular outcomes was evident with increasing number of components, with statistically elevated risk for ≥3 (NCEP) components in men but for ≥2 components in women. Exploratory analyses of alternative metabolic syndrome criteria suggest cardiovascular risk estimates comparable to those derived by using NCEP, but criteria evaluating risk on more of a continuum would potentially allow consideration of alternative definitions by gender or for patients with other risk factors.

Keywords: cardiovascular diseases; metabolic syndrome X; morbidity; mortality; CART, classification and regression tree; HDL, high density lipoprotein; NCEP, National Cholesterol Education Program Adult Treatment Panel 3; WHO, World Health Organization

Journal Article.  6411 words.  Illustrated.

Subjects: Public Health and Epidemiology

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