Is metabolic syndrome a discrete entity in the general population? Evidence from the Caerphilly and Speedwell population studies

Yarnell, John; Patterson, Christopher; Bainton, David; Sweetnam, P. M.

doi:10.1136/hrt.79.3.248

Cited by 60 publications

(39 citation statements)

References 35 publications

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“…Full details of all laboratory methods used for determination of fasting insulin, glucose and lipid parameters have been reported in detail elsewhere. 14 …”

Section: Study Population and Survey Methodsmentioning

confidence: 99%

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Central obesity: predictive value of skinfold measurements for subsequent ischaemic heart disease at 14 years follow-up in the Caerphilly Study

et al. 2001

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OBJECTIVE:To assess the predictive value of central obesity for risk of ischaemic heart disease (IHD) in a long-term follow-up, measured by skinfold thickness in comparison to general measures of overweight and obesity such as Quetelet's index. SUBJECTS AND DESIGN: A total of 2512 men aged 45 -59 y from the general population first examined in 1979 -1982. Men were re-examined at approximately 5 y intervals. All fatal and non-fatal cases of IHD during a 14 y follow-up were recorded. MEASUREMENTS: Skinfold thickness was measured at four sites. Height (m) and weight (kg) were also measured and Quetelet's index (weight=height 2 ) was used as the reference body mass index (BMI). RESULTS: Data were available for 2512 men among whom 411 new cases of IHD (fatal and non-fatal) occurred during 14 y of follow-up. Increasing values of BMI showed a statistically significant trend with increasing risk of new IHD that contributed independently to risk of IHD when adjusted for age, smoking habit and social class. Skinfold thickness measures were entered singly and in combination into this model with and without the additional inclusion of BMI. All individual skinfolds were significantly associated with risk of new IHD when BMI was excluded from the regression model, as was the sum of four skinfolds and the sum of subscapular and abdominal skinfolds. Only the subscapular skinfold measure contributed independently to risk of subsequent IHD when BMI was included in the model although biceps, biceps plus triceps and total sum of skinfolds were close to achieving statistical significance. The relative odds of IHD in the upper quintile of subscapular skinfold compared to the lowest was 1.9 (95% CI 1.3 -2.8) when adjusted for age, smoking habit and social class. CONCLUSIONS: In general skinfold measurements contribute only marginally to improved prediction of risk of IHD as measured by BMI, but central obesity, as measured by the subscapular skinfold, is predictive of IHD independently of BMI.

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“…Full details of all laboratory methods used for determination of fasting insulin, glucose and lipid parameters have been reported in detail elsewhere. 14 …”

Section: Study Population and Survey Methodsmentioning

confidence: 99%

“…Survey methods have been described in detail previously. 13,14 Laboratory methods All blood samples were taken with minimum haemostasis after an overnight fast. Full details of all laboratory methods used for determination of fasting insulin, glucose and lipid parameters have been reported in detail elsewhere.…”

Section: Study Population and Survey Methodsmentioning

confidence: 99%

Central obesity: predictive value of skinfold measurements for subsequent ischaemic heart disease at 14 years follow-up in the Caerphilly Study

et al. 2001

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“…Individuals with any four-, five-, or six-component groupings had no greater excess IMT than the sum of the same factors taken separately. The cross-sectional studies by Alexander et al (44) and Yarnell et al (101) showed that the impact of the syndrome on CVD was greatly attenuated in a multivariate analysis by controlling for certain of its components, thereby suggesting that the whole is not greater than its parts. Also, in a prospective study of diabetic and nondiabetic subjects free of CVD and followed for an average of 11 years, the risk of incident CHD associated with the syndrome was no greater than that explained by the presence of its components (34).…”

Section: Diabetes Care 28:2289 -2304 2005mentioning

confidence: 99%

The Metabolic Syndrome: Time for a Critical Appraisal

et al. 2005

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The term "metabolic syndrome" refers to a clustering of specific cardiovascular disease (CVD) risk factors whose underlying pathophysiology is thought to be related to insulin resistance. Since the term is widely used in research and clinical practice, we undertook an extensive review of the literature in relation to the syndrome's definition, underlying pathogenesis, and association with CVD and to the goals and impact of treatment. While there is no question that certain CVD risk factors are prone to cluster, we found that the metabolic syndrome has been imprecisely defined, there is a lack of certainty regarding its pathogenesis, and there is considerable doubt regarding its value as a CVD risk marker. Our analysis indicates that too much critically important information is missing to warrant its designation as a "syndrome." Until much needed research is completed, clinicians should evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the "metabolic syndrome." Diabetes Care 28:2289 -2304, 2005F or most of the 20th century, cardiovascular disease (CVD) was identified as the major cause of morbidity and mortality in the developed world. During this period there was considerable effort to understand the underlying biology of the disease and to identify the contributing risk factors. As risk factors were identified, it became apparent that more than one were often present in the same individual. Toward the end of the century, the clustering of CVD risk factors was first described, most notably the simultaneous presence of obesity, type 2 diabetes, hyperlipidemia, and hypertension (1-3). Although insulin resistance (i.e., resistance to insulin-stimulated glucose uptake) as a feature of type 2 diabetes was first described many years earlier (4), hyperinsulinemia was also found to be a key feature of type 2 diabetes (5,6), as well as hyperlipidemia (7-9), obesity (10 -13), and hypertension (12)(13)(14). In addition, a cluster of heart disease risk factors seemed clearly related to type 2 diabetes (15).This risk factor clustering, and its association with insulin resistance, led investigators to propose the existence of a unique pathophysiological condition, called the "metabolic" (1-3) or "insulin resistance" (11) syndrome. This concept was unified and extended with the landmark publication of Reaven's 1988 Banting Medal award lecture (16). Reaven postulated that insulin resistance and its compensatory hyperinsulinemia predisposed patients to hypertension, hyperlipidemia, and diabetes and thus was the underlying cause of much CVD. Although obesity was not included in Reaven's primary list of disorders caused by insulin resistance, he acknowledged that it, too, was correlated with insulin resistance or hyperinsulinemia, and that the obvious "treatment" for what he termed "syndrome X" was weight maintenance (or weight loss) and physical activity.Reaven's seminal paper was followed by many studies documenting the clustering of CVD risk factors and their relatio...

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“…13 Some investigators have even questioned the existence of a distinct IRS. 14 There is some evidence from cell biology and experimental research supporting the direct effect of insulin on atherosclerosis, 7 but the current balance of evidence gives more support to the view that the association of hyperinsulinemia with atherosclerotic vascular diseases is mediated through the clustering of other cardiovascular risk factors with hyperinsulinemia and the underlying insulin resistance. 8,15 In the 22-year follow-up of the Helsinki Policemen Study, 2 hyperinsulinemia was found to predict the risk of CHD independently of other risk factors, whereas the positive association between hyperinsulinemia and the risk of stroke became nonsignificant after adjustment for other risk factors.…”

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confidence: 99%

Insulin Resistance Syndrome Predicts the Risk of Coronary Heart Disease and Stroke in Healthy Middle-Aged Men

Pyörälä

Miettinen

Halonen

et al. 2000

ATVB

308

124

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Abstract-The interpretation of conventional multivariate analyses concerning the relation of insulin to the risk of atherosclerotic disease is complex because of correlations of insulin with other risk factors. Therefore, we applied factor analysis to study the clustering of risk factors in the baseline data of the Helsinki Policemen Study (970 healthy men aged 34 to 64 years) and investigated whether these clusterings predict coronary heart disease (CHD) and stroke risk. Areas under the glucose and insulin response curves (AUC glucose and AUC insulin) were used to reflect glucose and insulin levels during oral glucose tolerance tests. During the 22-year follow-up, 164 men had a CHD event, and 70 men had a stroke. Factor analysis of 10 risk factor variables produced 3 underlying factors: insulin resistance factor (comprising body mass index, subscapular skinfold, AUC insulin, AUC glucose, maximal O 2 uptake, mean blood pressure, and triglycerides), lipid factor (cholesterol and triglycerides), and lifestyle factor (physical activity and smoking). In multivariate Cox models, the age-adjusted hazard ratio for insulin resistance factor during the 22-year follow-up was 1.28 (95% CI 1.10 to 1.50) with regard to CHD risk and 1.64 (95% CI 1.29 to 2.08) with regard to stroke risk. Lipid factor predicted the risk of CHD but not that of stroke, and lifestyle factor predicted a reduced CHD risk.Factor analysis including only 6 risk factor variables proposed to be central components of insulin resistance syndrome (body mass index, subscapular skinfold, AUC insulin, AUC glucose, mean blood pressure, and triglycerides) produced only a single insulin resistance factor that predicted the risk of CHD and stroke independently of other risk factors. Key Words: coronary disease Ⅲ epidemiology Ⅲ insulin Ⅲ insulin resistance syndrome Ⅲ stroke T he association of hyperinsulinemia with the risk of coronary heart disease (CHD) has been demonstrated in several, but not in all, prospective studies. 1,2 Some prospective studies have also shown an association between hyperinsulinemia and the risk of stroke. [3][4][5][6] However, the results of those prospective studies that have shown a positive association between insulin and the risk of CHD and stroke have varied with regard to the outcome of multivariate analyses, with some studies finding and other studies not finding insulin to predict the risk independently of other cardiovascular risk factors.Two main mechanisms have been proposed to explain the association of hyperinsulinemia with atherosclerotic vascular disease: (1) a direct effect of insulin on the arterial wall 7 and (2) an effect mediated through a clustering of several other risk factors with hyperinsulinemia. 8 In 1988, Reaven 9 introduced the concept of syndrome X, which was later named insulin resistance syndrome (IRS) or metabolic syndrome. According to this concept, the underlying factor is the resistance of peripheral tissues, mainly skeletal muscle, to insulin-mediated glucose disposal, leading to hyperinsulinemia. Othe...

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Is metabolic syndrome a discrete entity in the general population? Evidence from the Caerphilly and Speedwell population studies

Cited by 60 publications

References 35 publications

Central obesity: predictive value of skinfold measurements for subsequent ischaemic heart disease at 14 years follow-up in the Caerphilly Study

Central obesity: predictive value of skinfold measurements for subsequent ischaemic heart disease at 14 years follow-up in the Caerphilly Study

The Metabolic Syndrome: Time for a Critical Appraisal

Insulin Resistance Syndrome Predicts the Risk of Coronary Heart Disease and Stroke in Healthy Middle-Aged Men

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