The metabolic syndrome and cardiovascular risk in the British Regional Heart Study

Abstract

Objective: To evaluate the metabolic syndrome as an overall risk assessment tool for cardiovascular disease (CVD) and diabetes in middle-aged British men. Design: Prospective study. Subjects: A total of 5128 men aged 40-59 years with no history of CVD or diabetes drawn from general practices in 24 British towns and followed up for 20 years. Results: The metabolic syndrome (National Cholesterol Expert Panel definition) is associated with a significant increase in risk of total CHD (myocardial infarction, angina or CHD death) (relative risk (RR), 95% CI: 1.57, 1.39-1.97), stroke (1.61, 95% CI: 1.26-2.06) and type 2 diabetes (3.57, 95% CI: 2.83-4.50) and is a far stronger predictor of diabetes than of total CHD and stroke in middle-aged men. The metabolic syndrome was inferior to the Framingham Risk Score in predicting total CHD or major CVD over 20 years (area under the curve (AUC) 0.58 vs 0.66 for both CHD and CVD; Po0.0001 for difference) but was superior in predicting diabetes (AUC 0.70 vs 0.60; Po0.001). However, absolute risk of developing CVD or diabetes over 20 years in those with three or more abnormalities was very high, ranging from 41.8% in those with three abnormalities to over a 50% chance in those with four of five abnormalities, comparable to the absolute incidence rates in the top 2 fifths of the Framingham distribution. Conclusion: While the initial aim to use the metabolic syndrome to improve risk prediction of CHD has been disappointing, the syndrome identifies patients at high risk of both diabetes and CVD who may derive benefit from lifestyle intervention.

Metabolic syndrome, endocrine disruptors and prostate cancer associations: biochemical and pathophysiological evidences

“…Numerous studies demonstrate that MS predisposing to different chronic disease characteristics of western countries like non-insulin dependent diabetes (NIDS) [6], psoriasis [7], obesity [8], cardiovascular diseases (CVD) [9, 10], osteoarthritis [11], neurodegenerative diseases like Alzheimer syndrome [12], the most common hormone-dependent tumours like breast [13] and prostate [14], as well as pancreas [15], colorectal cancer [16] and hepatocellular carcinoma [17]…”

An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia

“…In a word, it is doubtful that risk associated with the metabolic syndrome is entirely subsumed by Framingham risk scoring. Moreover, there is little doubt that the metabolic syndrome is a stronger predictor of type 2 diabetes than is Framingham risk scoring (Wannamethee 2008;Wannamethee et al 2005). …”

Metabolic syndrome and lifestyle modification

“…The risk assessment based on such diagnostic criteria are therefore at risk of inaccuracy and might be misleading. The risk for future development of CVD and type 2 diabetes mellitus should be estimated rather by the risk prediction tools developed for the purposes [66][67][68][69][70].…”