Kadota Aya, Hozawa Atsushi, Okamura Tomonori, Kadowak Takashi, Nakmaura Koshi, Murakami Yoshitaka, Hayakawa Takehito, Kita Yoshikuni, Okayama Akira, Nakamura Yasuyuki, Kashiwagi Atsunori, Ueshima Hirotsugu
Department of Health Science, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Japan.
Diabetes Care. 2007 Jun;30(6):1533-8. doi: 10.2337/dc06-2074. Epub 2007 Mar 15.
Metabolic syndrome is diagnosed according to several criteria. Of these, some require glucose intolerance and others require obesity for the diagnosis. We investigated the relationship between metabolic risk factor clustering and cardiovascular disease (CVD) mortality stratified by high blood glucose or obesity.
We followed 7,219 Japanese men and women without a history of CVD for 9.6 years. We defined high blood pressure, high blood glucose, high triglycerides, low HDL cholesterol, and obesity as metabolic factors. The multivariate adjusted hazard ratio (HR) for CVD mortality according to the number of clustering metabolic factors was calculated using the Cox proportional hazards model.
During follow-up, 173 participants died of CVD. The numbers of metabolic risk factors and CVD mortality were positively correlated (P(trend) = 0.07). The HR was obviously higher among participants with than among those without high blood glucose and clustering of > or =2 other metabolic risk factors (HR 3.67 [95% CI 1.49-9.03]). However, the risk increase was only modest in participants without high blood glucose even if they had > or =2 other metabolic risk factors (1.99 [0.93-4.28]). Conversely, metabolic risk factor clustering was related to CVD mortality irrespective of obesity.
Our findings suggest that glucose tolerance plays an important role in CVD mortality. Because the prevalence of nonobese participants with several metabolic risk factors was quite high and their CVD risk was high, excluding them from the diagnosis of metabolic syndrome because of the absence of obesity might overlook their risk.
代谢综合征是根据多种标准进行诊断的。其中，一些标准要求存在糖耐量异常，而另一些则要求存在肥胖才能诊断。我们研究了按高血糖或肥胖分层的代谢危险因素聚集与心血管疾病（CVD）死亡率之间的关系。
我们对7219名无CVD病史的日本男性和女性进行了9.6年的随访。我们将高血压、高血糖、高甘油三酯、低高密度脂蛋白胆固醇和肥胖定义为代谢因素。使用Cox比例风险模型计算根据聚集的代谢因素数量得出的CVD死亡率的多变量调整风险比（HR）。
在随访期间，173名参与者死于CVD。代谢危险因素的数量与CVD死亡率呈正相关（P趋势 = 0.07）。在有高血糖且聚集≥2种其他代谢危险因素的参与者中，HR明显高于无高血糖者（HR 3.67 [95% CI 1.49 - 9.03]）。然而，即使没有高血糖但有≥2种其他代谢危险因素的参与者，风险增加也仅为适度（1.99 [0.93 - 4.28]）。相反，无论肥胖情况如何，代谢危险因素聚集均与CVD死亡率相关。
我们的研究结果表明糖耐量在CVD死亡率中起重要作用。由于有多种代谢危险因素的非肥胖参与者患病率相当高且其CVD风险较高，因无肥胖而将他们排除在代谢综合征诊断之外可能会忽视他们的风险。
