The importance of diagnostic criteria in the association between the metabolic syndrome and cardiovascular disease in obese subjects

• Published in: International Journal of Obesity Vol. 29; no. 6; pp. 668 - 674
• Main Authors: VIDAL, J, MORINIGO, R, CODOCEO, V. H, CASAMITJANA, R, PELLITERO, S, GOMIS, R
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing 01-06-2005; Nature Publishing Group
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Blood pressure; Body Composition; Body Mass Index; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - etiology; Cholesterol; Cholesterol, HDL - blood; Cross-Sectional Studies; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Excretion; Fasting; Female; Glucose Tolerance Test; Humans; Hypertension; Insulin; Insulin - blood; Male; Medical sciences; Metabolic diseases; Metabolic disorders; Metabolic Syndrome - blood; Metabolic Syndrome - complications; Metabolic Syndrome - diagnosis; Middle Aged; Miscellaneous; Obesity; Obesity - blood; Obesity - complications; Other metabolic disorders; Predictive Value of Tests; Risk factors; Triglycerides - blood; Endocrinopathy; Human; Obesity; Diabetes mellitus; Nutrition disorder; Cardiovascular disease; Metabolic diseases; metabolic syndrome; Association; X Syndrome; Diagnosis; diabetes; Nutritional status
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/sj.ijo.0802921

To investigate whether the association between the metabolic syndrome (MS) and cardiovascular disease (CVD) in obese adults is influenced by the criteria used to diagnose the MS.
Cross-sectional study in 389 obese adults (male/female: 26%/74%; body mass index (BMI): 30.1-63.2 kg/m2; age: 18-79 y).
To diagnose the MS by the WHO or the ATPIII criteria, body mass index, waist circumference, fasting and 2-h oral Glucose tolerance test plasma glucose, fasting plasma triglycerides and HDL cholesterol, systolic and diastolic blood pressure, 24-h albumin excretion, and fasting insulin were measured. The association between the MS diagnosed with either definition and self-referred CVD was investigated.
The prevalence of the MS by the WHO was higher than by the ATPIII criteria (WHO 69.1%, ATPIII 49.4%; P<0.001). The MS diagnosed by the WHO criteria was significantly associated with self-referred CVD (odds ratio (OR) 5.80, 95% CI 1.35-24.95, P<0.05), whereas the ATPIIII MS was not (OR 1.34, 95% CI 0.59-3.03). An elevated blood pressure (OR 5.04, 95% CI 1.41-18.01, P<0.05) and microalbuminuria (OR 2.61, 95% CI 1.06-6.40, P<0.05) were independently associated with CVD. Consideration of the OGTT data as part of the ATPIII MS definition improved its associations with CVD (OR 4.39, 95% CI 1.29-14.94, P<0.05).
The WHO criteria appear to identify a greater number of obese adults at risk for CVD. Nevertheless, the addition of an OGTT at least in nondiabetic patients with two ATPIII-defined metabolic risk factors may help to improve the association between the MS and CVD in obese adults.