Evaluating CMR

Metabolic Syndrome and Type 2 Diabetes/CVD Risk

Comparison of Screening Tools

The San Antonio Heart Study

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Lorenzo et al. (3) used data from the San Antonio Heart Study to compare NCEP-ATP III, IDF, and WHO screening tools in predicting CVD and diabetes incidence. The San Antonio Heart Study recruited 2,559 Mexican American and non-Hispanic white individuals and followed them for an average of 7.4 years. Metabolic syndrome prevalence was higher when IDF criteria were used and lower when WHO criteria were used. During the follow-up, 93 men and 63 women developed CVD events and 195 subjects developed diabetes. NCEP-ATP III, IDF, and WHO clinical criteria yielded an OR for CVD events of 2.00 (95% CI, 1.33-3.01), 1.69 (95% CI, 1.13-2.54), and 1.73 (95% CI, 1.12-2.67), respectively. The various criteria predicted CVD incidence independent of age, sex, ethnicity, type 2 diabetes, non-HDL cholesterol (VLDL + IDL + LDL cholesterol fractions), smoking, and personal and family history of CVD. With respect to diabetes risk, the respective ORs were 6.90 (95% CI, 4.97-9.58), 5.76 (95% CI, 4.11-9.07), and 6.67 (95% CI, 4.75-9.35) for NCEP-ATP III, IDF, and WHO criteria. In subjects free of CVD at baseline, the ORs for CVD and diabetes risk were similar with all three proposed screening tools, but the IDF tools showed greater sensitivity and higher false positive rates. The authors explored whether the presence of the metabolic syndrome enhanced risk prediction in addition to age. Selected age cut-off values were 45 years for men and 55 years for women. The authors found that the metabolic syndrome was better able to predict CVD in men 45 and over and in women 55 and over. They also suggested that, for both men and women, adding diagnosis of the metabolic syndrome to traditional risk factors included in the Framingham risk score could enhance CVD prediction. The combination of traditional CVD risk markers and emerging markers could heighten sensitivity, particularly in older individuals.


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3. Lorenzo C, Okoloise M, Williams K, et al. The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study. Diabetes Care 2003; 26: 3153-9.