Sattar Naveed, McConnachie Alex, Shaper A Gerald, Blauw Gerard J, Buckley Brendan M, de Craen Anton J, Ford Ian, Forouhi Nita G, Freeman Dilys J, Jukema J Wouter, Lennon Lucy, Macfarlane Peter W, Murphy Michael B, Packard Chris J, Stott David J, Westendorp Rudi G, Whincup Peter H, Shepherd James, Wannamethee S Goya
Faculty of Medicine, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Lancet. 2008 Jun 7;371(9628):1927-35. doi: 10.1016/S0140-6736(08)60602-9. Epub 2008 May 22.
Clinical use of criteria for metabolic syndrome to simultaneously predict risk of cardiovascular disease and diabetes remains uncertain. We investigated to what extent metabolic syndrome and its individual components were related to risk for these two diseases in elderly populations.
We related metabolic syndrome (defined on the basis of criteria from the Third Report of the National Cholesterol Education Program) and its five individual components to the risk of events of incident cardiovascular disease and type 2 diabetes in 4812 non-diabetic individuals aged 70-82 years from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). We corroborated these data in a second prospective study (the British Regional Heart Study [BRHS]) of 2737 non-diabetic men aged 60-79 years.
In PROSPER, 772 cases of incident cardiovascular disease and 287 of diabetes occurred over 3.2 years. Metabolic syndrome was not associated with increased risk of cardiovascular disease in those without baseline disease (hazard ratio 1.07 [95% CI 0.86-1.32]) but was associated with increased risk of diabetes (4.41 [3.33-5.84]) as was each of its components, particularly fasting glucose (18.4 [13.9-24.5]). Results were similar in participants with existing cardiovascular disease. In BRHS, 440 cases of incident cardiovascular disease and 105 of diabetes occurred over 7 years. Metabolic syndrome was modestly associated with incident cardiovascular disease (relative risk 1.27 [1.04-1.56]) despite strong association with diabetes (7.47 [4.90-11.46]). In both studies, body-mass index or waist circumference, triglyceride, and glucose cutoff points were not associated with risk of cardiovascular disease, but all five components were associated with risk of new-onset diabetes.
Metabolic syndrome and its components are associated with type 2 diabetes but have weak or no association with vascular risk in elderly populations, suggesting that attempts to define criteria that simultaneously predict risk for both cardiovascular disease and diabetes are unhelpful. Clinical focus should remain on establishing optimum risk algorithms for each disease.
代谢综合征标准在临床中用于同时预测心血管疾病和糖尿病风险的应用仍不明确。我们研究了代谢综合征及其各个组分在老年人群中与这两种疾病风险的关联程度。
我们将代谢综合征（根据美国国家胆固醇教育计划第三次报告的标准定义）及其五个组分与4812名年龄在70 - 82岁、来自老年人普伐他汀前瞻性研究（PROSPER）的非糖尿病个体发生心血管疾病事件和2型糖尿病的风险进行关联分析。我们在第二项前瞻性研究（英国地区心脏研究[BRHS]）中，对2737名年龄在60 - 79岁的非糖尿病男性的数据进行了验证。
在PROSPER研究中，在3.2年的时间里发生了772例心血管疾病事件和287例糖尿病事件。在无基线疾病的人群中，代谢综合征与心血管疾病风险增加无关（风险比1.07[95%可信区间0.86 - 1.32]），但与糖尿病风险增加有关（4.41[3.33 - 5.84]），其各个组分也是如此，尤其是空腹血糖（18.4[13.9 - 24.5]）。在已有心血管疾病的参与者中结果相似。在BRHS研究中，在7年的时间里发生了440例心血管疾病事件和105例糖尿病事件。代谢综合征与心血管疾病事件有一定关联（相对风险1.27[1.04 - 1.56]），尽管与糖尿病有很强的关联（7.47[4.90 - 11.46]）。在两项研究中，体重指数或腰围、甘油三酯和血糖切点与心血管疾病风险无关，但所有五个组分均与新发糖尿病风险有关。
代谢综合征及其组分与2型糖尿病有关，但在老年人群中与血管风险的关联较弱或无关联，这表明试图定义同时预测心血管疾病和糖尿病风险的标准是无益的。临床重点应仍然是为每种疾病建立最佳风险算法。
