Evaluating CMR

Metabolic Syndrome and Type 2 Diabetes/CVD Risk

Comparison of Screening Tools

Additional Evidence

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Tankó et al. (8) sought to compare NCEP-ATP III criteria and the hypertriglyceridemic waist phenotype in predicting accelerated atherogenesis and related cardiovascular mortality in 557 postmenopausal women followed for 8.5±0.3 years. At baseline, hypertriglyceridemic waist prevalence was 15.8% and metabolic syndrome prevalence was 17.6% with NCEP-ATP III criteria. After adjusting for age, smoking, and LDL cholesterol levels, hypertriglyceridemic waist was associated with an HR of 4.7 (95% CI, 2.2-9.8, p<0.001), while the corresponding HR was 3.2 (95% CI, 1.5-6.5, p<0.001) for NCEP-ATP III. Interestingly, the authors found that women with hypertriglyceridemic waist who did not meet NCEP-ATP III criteria were nevertheless at increased risk compared to women who did meet NCEP-ATP III criteria but did not have the hypertriglyceridemic waist phenotype. The authors concluded that hypertriglyceridemic waist provides greater, if not at least similar, sensitivity than NCEP-ATP III criteria at much lower cost to healthcare systems.

In conclusion, the metabolic syndrome as diagnosed by any of the major organizations increases the risk of developing CVD events and type 2 diabetes in particular. Generally, NCEP-ATP III clinical criteria predict CVD risk better than other criteria. However, very few studies have compared the ability of clinical criteria to predict diabetes risk. Since WHO criteria usually indicate a CVD risk that is similar to that of the other screening tools, measuring microalbuminuria and insulin sensitivity with clamp techniques does not seem necessary in order to diagnose the metabolic syndrome.

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8. Tanko LB, Bagger YZ, Qin G, et al. Enlarged waist combined with elevated triglycerides is a strong predictor of accelerated atherogenesis and related cardiovascular mortality in postmenopausal women. Circulation 2005; 111: 1883-90.