Assmann Gerd, Guerra Rudy, Fox Garrett, Cullen Paul, Schulte Helmut, Willett DuWayne, Grundy Scott M
Leibniz Institute of Arteriosclerosis Research, University of Münster, Münster, Germany.
Am J Cardiol. 2007 Feb 15;99(4):541-8. doi: 10.1016/j.amjcard.2006.08.045. Epub 2007 Jan 2.
The 2 most widely used criteria to diagnose the metabolic syndrome (MS) are those developed by the United States Adult Treatment Panel III of the National Cholesterol Education Program (ATP III) and by the International Diabetes Federation (IDF). A major difference between these 2 sets of criteria is that the IDF places more emphasis on waist circumference. We compared the prevalence of MS using the ATP III and the IDF guidelines in 2 American (the Dallas Health Study and National Health and Nutrition Examination Survey) and 1 German (Prospective Cardiovascular Munster study) population samples. When the ATP III criteria were used, the prevalence of MS was higher in the United States than the German samples in both women (37% vs. 18%) and men (30% vs 25%), whereas when the IDF criteria were used, the prevalence of MS was 25% higher in the German than the American sample. Although in the United States both sets of criteria identified mostly the same people (concordance of about 90%), this was less true in Germany (concordance about 80%). To determine which criteria better predicted adverse cardiovascular outcomes, the incidence of coronary events associated with MS, as defined using the ATP III or the IDF criteria, were compared over a 10-year period among the middle-aged men in the German sample (n = 7,152). A total of 3.4% of men without MS developed an event. A much higher percentage of the men with MS defined by the ATP III criteria (10.7%) than the IDF criteria (5.5%) had a cardiovascular event. In conclusion, although the prevalence of MS was higher when the IDF criteria were used in the German sample, the IDF criteria have lower predictive power for coronary events.
诊断代谢综合征（MS）最广泛使用的两个标准是由美国国家胆固醇教育计划成人治疗小组第三次报告（ATP III）和国际糖尿病联盟（IDF）制定的。这两套标准的一个主要区别在于，IDF更强调腰围。我们在美国的两个（达拉斯健康研究和国家健康与营养检查调查）以及德国的一个（明斯特前瞻性心血管研究）人群样本中，使用ATP III和IDF指南比较了MS的患病率。当使用ATP III标准时，美国女性（37%对18%）和男性（30%对25%）的MS患病率均高于德国样本；而当使用IDF标准时，德国样本的MS患病率比美国样本高25%。尽管在美国这两套标准识别出的大多是同一批人（一致性约为90%），但在德国情况并非如此（一致性约为80%）。为了确定哪套标准能更好地预测不良心血管结局，在德国样本的中年男性（n = 7152）中，比较了使用ATP III或IDF标准定义的与MS相关的冠心病事件发生率，为期10年。共有3.4%无MS的男性发生了事件。由ATP III标准定义为患有MS的男性发生心血管事件的比例（10.7%）远高于由IDF标准定义的男性（5.5%）。总之，尽管在德国样本中使用IDF标准时MS患病率更高，但IDF标准对冠心病事件的预测能力较低。
