Evaluating CMR

Metabolic Syndrome and Type 2 Diabetes/CVD Risk

Comparison of Screening Tools

The DECODE Study

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The Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe (DECODE) study compared the ability of NCEP-ATP III, WHO, and IDF criteria to predict CVD deaths (5). The DECODE cohort included pooled data from European epidemiological studies on diabetes and impairment of glucose regulation in which oral glucose tolerance tests were performed. A total of 4,715 men and 5,554 women 30 to 89 years of age were followed for a period ranging from 7 to 16 years. Using WHO criteria, metabolic syndrome prevalence was 27.0% in men and 19.7% in women. Using NCEP-ATP III criteria, metabolic syndrome prevalence was 32.2% in men and 28.5% in women. Using IDF criteria, these figures were 35.9% in men and 34.1% in women. With respect to CVD deaths, the HRs for WHO clinical criteria were 2.09 (95% CI, 1.59-2.76) in men and 1.60 (95% CI, 1.01-2.51) in women. With NCEP-ATP III criteria, the corresponding HRs were 1.72 (95% CI, 1.31-2.26) and 1.09 (95% CI, 0.70-1.69), and the HRs were 1.51 (95% CI, 1.15-1.99) and 1.53 (95% CI, 0.99-2.36) using IDF criteria. Paired homogeneity tests were performed to compare proposed criteria and CVD death risk. In men, there was no difference between NCEP-ATP III and WHO criteria in predicting CVD death, while risk was lower in women with NCEP-ATP III criteria. Compared to IDF criteria, NCEP-ATP III criteria predicted risk similarly in both men and women. With WHO and IDF criteria, risk prediction was similar in women, while in men, risk prediction was stronger with WHO criteria. In the DECODE study, WHO clinical criteria seemed to predict CVD death risk best, and this association was generally stronger in men than in women.

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5. Qiao Q. Comparison of different definitions of the metabolic syndrome in relation to cardiovascular mortality in European men and women. Diabetologia 2006; 49: 2837-46.