Department of Preventive Medicine and Public Health, Keio University, Shinjuku-ku, Tokyo 160-8582, Japan.
Atherosclerosis. 2011 Jul;217(1):201-6. doi: 10.1016/j.atherosclerosis.2011.03.010. Epub 2011 Mar 15.
Recently, several major organizations have proposed a unified definition for the metabolic syndrome (MetS), which should be evaluated in multiethnic groups. The effect of Mets on the incidence of cardiovascular disease needs to be assessed after adjusting for serum low density lipoprotein cholesterol (LDLC), a major risk factor for atherosclerotic diseases. This is especially needed to be evaluated in Asian populations with low incidence of coronary artery disease (CAD).
We conducted a 13-year prospective study of 4939 Japanese living in an urban area. The MetS was defined using a unified classification that included cut-off points for waist circumference in Asians. The multivariable adjusted hazard ratios (HRs) of MetS for CAD and stroke were calculated using a Cox proportional model adjusted for other potential confounding factors with LDLC.
During the follow-up period, there were 155 cases of CAD and 204 of stroke including 118 cerebral infarctions. In participants under 65 years old, the multivariable HRs of MetS for CAD were 1.21 (95% C.I., 0.64-2.28) in men and 4.44 (95% C.I., 1.73-11.4) in women; the HRs for ischemic stroke were 3.24 (95% C.I., 1.55-6.77) in men and 3.99 (95% C.I., 1.34-11.8) in women. In participants aged 65 years old and over, MetS only showed a significant association with CAD in men (HR 1.89, 95% C.I., 1.11-3.21). Serum LDLC was associated with increased risk of CAD in men irrespective of age group; however, it was not associated with CAD in women. There was no association between serum LDLC and ischemic stroke in any group stratified by sex and the age of 65. These results indicate that the new uniform MetS definition is useful for detecting high risk individuals, especially for middle-aged population. However, continuous screening for hypercholesterolemia is necessary to prevent CAD, especially in men, even in Asian countries such as Japan.
最近，几个主要组织提出了代谢综合征（MetS）的统一定义，该定义应在多种族群体中进行评估。需要评估 Mets 对心血管疾病发病率的影响，同时要考虑到血清低密度脂蛋白胆固醇（LDLC），这是动脉粥样硬化疾病的一个主要危险因素。这在冠心病（CAD）发病率较低的亚洲人群中尤其需要进行评估。
我们对居住在城市地区的 4939 名日本人进行了为期 13 年的前瞻性研究。采用亚洲人腰围切点的统一分类标准来定义 MetS。使用 Cox 比例模型计算校正其他潜在混杂因素（包括 LDLC）后 MetS 与 CAD 和中风的多变量调整后的风险比（HR）。
在随访期间，有 155 例 CAD 和 204 例中风，其中包括 118 例脑梗死。在年龄在 65 岁以下的参与者中，MetS 与 CAD 的多变量 HR 在男性中为 1.21（95%置信区间，0.64-2.28），在女性中为 4.44（95%置信区间，1.73-11.4）；缺血性中风的 HR 在男性中为 3.24（95%置信区间，1.55-6.77），在女性中为 3.99（95%置信区间，1.34-11.8）。在年龄在 65 岁及以上的参与者中，MetS 仅与男性的 CAD 显著相关（HR 1.89，95%置信区间，1.11-3.21）。血清 LDLC 与不论年龄组的男性 CAD 风险增加相关；然而，它与女性 CAD 无关。在按性别和 65 岁年龄分层的任何组中，血清 LDLC 与缺血性中风均无关。这些结果表明，新的统一 MetS 定义有助于发现高危人群，特别是中年人群。然而，即使在日本等亚洲国家，也需要对高胆固醇血症进行持续筛查，以预防 CAD，尤其是男性。
