van Herpt Thijs T W, Dehghan Abbas, van Hoek Mandy, Ikram M Arfan, Hofman Albert, Sijbrands Eric J G, Franco Oscar H
Department of Epidemiology, Erasmus Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Internal Medicine, Erasmus Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Cardiovasc Diabetol. 2016 Apr 27;15:69. doi: 10.1186/s12933-016-0387-4.
To evaluate the clinical value of metabolic syndrome based on different definitions [American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI), International Diabetes Federation (IDF) and European Group for the Study of Insulin Resistance (EGIR)] in middle-aged and elderly populations.
We studied 8643 participants from the Rotterdam study (1990-2012; mean age 62.7; 57.6 % female), a large prospective population-based study with predominantly elderly participants. We performed cox-proportional hazards models for different definitions, triads within definitions and each separate component for the risk of incident type 2 diabetes mellitus, coronary heart disease, stroke, cardiovascular- and all-cause mortality.
In our population of 8643 subjects, metabolic syndrome was highly prevalent (prevalence between 19.4 and 42.4 %). Metabolic syndrome in general was associated with incident type 2 diabetes mellitus (median follow-up of 6.8 years, hazard ratios 3.13-3.78). The associations with coronary heart disease (median follow-up of 7.2 years, hazard ratios 1.08-1.32), stroke (median follow-up of 7.7 years, hazard ratios 0.98-1.32), cardiovascular mortality (median follow-up of 8.2 years, ratios 0.95-1.29) and all-cause mortality (median follow-up of 8.7 years, hazard ratios 1.05-1.10) were weaker. AHA/NHLBI- and IDF-definitions showed similar associations with clinical endpoints compared to the EGIR, which was only significantly associated with incident type 2 diabetes mellitus. All significant associations disappeared after correcting metabolic syndrome for its individual components.
Large variability exists between and within definitions of the metabolic syndrome with respect to risk of clinical events and mortality. In a relatively old population the metabolic syndrome did not show an additional predictive value on top of its individual components. So, besides as a manner of easy identification of high risk patients, the metabolic syndrome does not seem to add any predictive value for clinical practice.
评估基于不同定义[美国心脏协会/美国国立心肺血液研究所（AHA/NHLBI）、国际糖尿病联盟（IDF）和欧洲胰岛素抵抗研究组（EGIR）]的代谢综合征在中老年人群中的临床价值。
我们研究了鹿特丹研究（1990 - 2012年；平均年龄62.7岁；57.6%为女性）中的8643名参与者，这是一项以老年人为主的大型前瞻性人群研究。我们针对不同定义、定义内的三联征以及每个单独成分，对2型糖尿病、冠心病、中风、心血管疾病和全因死亡率的发病风险进行了Cox比例风险模型分析。
在我们的8643名受试者群体中，代谢综合征非常普遍（患病率在19.4%至42.4%之间）。总体而言，代谢综合征与2型糖尿病发病相关（中位随访6.8年，风险比3.13 - 3.78）。与冠心病（中位随访7.2年，风险比1.08 - 1.32）、中风（中位随访7.7年，风险比0.98 - 1.32）、心血管疾病死亡率（中位随访8.2年，风险比0.95 - 1.29）和全因死亡率（中位随访8.7年，风险比1.05 - 1.10）的关联较弱。与EGIR相比，AHA/NHLBI和IDF定义与临床终点的关联相似，EGIR仅与2型糖尿病发病显著相关。在对代谢综合征的各个成分进行校正后，所有显著关联均消失。
代谢综合征的不同定义之间以及定义内部在临床事件风险和死亡率方面存在很大差异。在相对老年的人群中，代谢综合征在其各个成分之外并未显示出额外的预测价值。因此，除了作为一种识别高危患者的简便方式外，代谢综合征在临床实践中似乎并未增加任何预测价值。
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