Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
Department of Internal Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
Sci Rep. 2023 Sep 5;13(1):14621. doi: 10.1038/s41598-023-41546-y.
Traditional metabolic syndrome (MetS) criteria have several limitations, which hinder its use in clinical practice. To overcome the limitations, we investigated the association between age- and sex-specific continuous MetS severity score (cMetS-S) and cardiovascular disease (CVD) and mortality beyond MetS components in the framework of the Tehran Lipid and Glucose Study. Participants aged 20-60 years at baseline were included in the study. We excluded participants with CVD, cancer, use of corticosteroids, estimated glomerular filtration rate < 30 ml/min/1.73 m, and those who were pregnant. We evaluated the association between cMetS-S with CVD and mortality over 18 years of follow-up among 8500 participants with continuous and quantile approaches using the Cox proportional hazard regression model. In addition, the model performance of cMetS-S for predicting CVD events was compared to the conventional MetS criteria. Participants with higher cMetS-S had a significantly increased risk for CVD, coronary (CHD) and non-coronary heart disease (non-CHD), and all-cause, cardiovascular, and sudden cardiac death. Independent of the confounders and MetS components, the cMetS-S had the HRs of 1.67 (95% CI 1.47-1.89), 1.60 (95% CI 1.37-1.86), and 1.88 (95% CI 1.50, 2.35) for CVD, CHD, and non-CHD events upon 1-SD increment, respectively. The risk of mortality was increased for 1-SD of cMetS-S (all-cause mortality, HR 1.24; 95% CI 1.09-1.41; CVD mortality, HR 1.72; 95% CI 1.20-2.45; sudden cardiac death, HR 1.60; 95% CI 1.03-2.49). The model fitness of cMetS-S was superior to the conventional MetS criteria in predicting CVD and mortality. The cMetS-S provided an additional risk for CVD and mortality beyond the individual MetS components. Standardized cMetS-S could be a potential universal measure to define MetS severity while considering the weighted contribution of MetS components and their variations by age, sex, and ethnicity.
传统的代谢综合征（MetS）标准存在多种局限性，这限制了其在临床实践中的应用。为了克服这些局限性，我们在德黑兰血脂和血糖研究的框架内，研究了年龄和性别特异性连续 MetS 严重程度评分（cMetS-S）与心血管疾病（CVD）和死亡率之间的关系，该评分超过了 MetS 成分。在基线时年龄为 20-60 岁的参与者被纳入研究。我们排除了患有 CVD、癌症、使用皮质类固醇、估计肾小球滤过率<30 ml/min/1.73 m 和怀孕的参与者。我们使用 Cox 比例风险回归模型，通过连续和分位数方法，在 8500 名参与者中评估了 cMetS-S 与 CVD 和 18 年随访期间死亡率之间的相关性。此外，还比较了 cMetS-S 预测 CVD 事件的模型性能与传统的 MetS 标准。cMetS-S 较高的参与者发生 CVD、冠心病（CHD）和非冠心病（非-CHD）以及全因、心血管和心源性猝死的风险显著增加。独立于混杂因素和 MetS 成分，cMetS-S 每增加 1 个标准差，CVD、CHD 和非-CHD 事件的 HR 分别为 1.67（95%CI 1.47-1.89）、1.60（95%CI 1.37-1.86）和 1.88（95%CI 1.50，2.35）。cMetS-S 增加 1 个标准差，全因死亡率（HR 1.24；95%CI 1.09-1.41）、CVD 死亡率（HR 1.72；95%CI 1.20-2.45）和心源性猝死（HR 1.60；95%CI 1.03-2.49）的风险增加。cMetS-S 的模型拟合度优于传统的 MetS 标准，可预测 CVD 和死亡率。cMetS-S 在个体 MetS 成分之外，为 CVD 和死亡率提供了额外的风险。标准化的 cMetS-S 可以成为定义 MetS 严重程度的潜在通用指标，同时考虑 MetS 成分的加权贡献及其随年龄、性别和种族的变化。
