Horm Metab Res 2007; 39(9): 642-650
DOI: 10.1055/s-2007-985822
Review

© Georg Thieme Verlag KG Stuttgart · New York

The Metabolic Syndrome and Risk of Cardiovascular Disease and Diabetes: Experiences with the New Diagnostic Criteria from the International Diabetes Federation

C. H. Saely[*] 1 , 2 , P. Rein[*] 1 , 2 , H. Drexel 1 , 2 , 3 , 4
  • 1Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
  • 2Department of Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
  • 3University for Human Sciences, Triesen, Principality of Liechtenstein
  • 4Drexel University College of Medicine, Philadelphia, PA, USA
Further Information

Publication History

received 15.05.2007

accepted 09.07.2007

Publication Date:
10 September 2007 (online)

Abstract

Since the publication of the International Diabetes Federation (IDF) consensus definition of the metabolic syndrome (MetS) in 2005, numerous studies have compared the new IDF MetS category with previous MetS definitions in its association with the prevalence of cardiovascular disease, and in its ability to predict vascular events and incident diabetes. The present review shows that the amount of cardiovascular risk conferred by the respective MetS definitions varies between populations; in most populations it is lower with the IDF MetS than with alternative MetS definitions. For incident diabetes, the number of existing studies appears too limited to draw definite conclusions. Like earlier definitions of the MetS, the IDF MetS is based on distinctive cutoff points for MetS stigmata, neglecting the fact that the risk factors are continuous and not categorical variables.

References

  • 1 Hanefeld M, Schaper F, Ceriello A. History and definition(s) of metabolic syndrome.  Internist (Berl). 2007;  48 117-125
  • 2 Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome.  Lancet. 2005;  365 1415-1428
  • 3 Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.  Diabet Med. 1998;  15 539-553
  • 4 World Health Organization .Definition, diagnosis, and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus: Report of a WHO consultation. Alwan A, King H, Eds. Geneva, World Health Org., Department of Noncommunicable Disease Surveillance 1999: 1-59
  • 5 Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR).  Diabet Med. 1999;  16 442-443
  • 6 Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) . Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III).  JAMA. 2001;  285 2486-2497
  • 7 Third Report of the National Cholesterol Education Program (NCEP) . Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report.  Circulation. 2002;  106 3143-3421
  • 8 Bloomgarden ZT. American Association of Clinical Endocrinologists (AACE) consensus conference on the insulin resistance syndrome: 25-26 August 2002, Washington, DC.  Diabetes Care. 2003;  26 933-939
  • 9 Grundy SM, Hansen B, Smith  Jr  SC, Cleeman JI, Kahn RA. Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management.  Circulation. 2004;  109 551-556
  • 10 Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith  Jr  SC, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.  Circulation. 2005;  112 2735-2752
  • 11 Schutte AE, Shemesh T, Rowley K, Best JD, MacDermott R, O’Dea K. The metabolic syndrome and changing relationship between blood pressure and insulin with age, as observed in Aboriginal and Torres Strait Islander peoples.  Diabet Med. 2005;  22 1589-1597
  • 12 Schwarz PE, Bornstein SR. Pre-diabetes and metabolic syndrome in Germans.  Horm Metab Res. 2006;  38 359
  • 13 Wenying Y, Zhaojun Y. Obesity and hypertension as two anthropometric predictors for metabolic syndrome.  Horm Metab Res. 2006;  38 469-470
  • 14 International Diabetes Federation . , The IDF consensus worldwide definition of the metabolic syndrome [article online] 2005;  , Available from http://www.idf.org/webdata/docs/metac_syndrome_def.pdf , Accessed on 19 October 2005
  • 15 Alberti KG, Zimmet P, Shaw J. The metabolic syndrome-a new worldwide definition.  Lancet. 2005;  366 1059-1062
  • 16 Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence.  Diabetes Care. 2005;  28 1769-1778
  • 17 Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, Montori VM. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies.  J Am Coll Cardiol. 2007;  49 403-414
  • 18 Lorenzo C, Okoloise M, Williams K, Stern MP, Haffner SM. The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study.  Diabetes Care. 2003;  26 3153-3159
  • 19 Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA. Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study.  Am J Epidemiol. 2002;  156 1070-1077
  • 20 Hanson RL, Imperatore G, Bennett PH, Knowler WC. Components of the “metabolic syndrome” and incidence of type 2 diabetes.  Diabetes. 2002;  51 3120-3127
  • 21 Athyros VG, Ganotakis ES, Elisaf MS, Liberopoulos EN, Goudevenos IA, Karagiannis A. Prevalence of vascular disease in metabolic syndrome using three proposed definitions.  Int J Cardiol. 2007;  117 204-210
  • 22 Choi KM, Kim SM, Kim YE, Choi DS, Baik SH, Lee J. Prevalence and cardiovascular disease risk of the metabolic syndrome using National Cholesterol Education Program and International Diabetes Federation definitions in the Korean population.  Metabolism. 2007;  56 552-558
  • 23 He Y, Jiang B, Wang J, Feng K, Chang Q, Fan L, Li X, Hu FB. Prevalence of the metabolic syndrome and its relation to cardiovascular disease in an elderly Chinese population.  J Am Coll Cardiol. 2006;  47 1588-1594
  • 24 Lu B, Yang Y, Song X, Dong X, Zhang Z, Zhou L, Li Y, Zhao N, Zhu X, Hu R. An evaluation of the International Diabetes Federation definition of metabolic syndrome in Chinese patients older than 30 years and diagnosed with type 2 diabetes mellitus.  Metabolism. 2006;  55 1088-1096
  • 25 Skilton MR, Moulin P, Serusclat A, Nony P, Bonnet F. A comparison of the NCEP-ATPIII, IDF and AHA/NHLBI metabolic syndrome definitions with relation to early carotid atherosclerosis in subjects with hypercholesterolemia or at risk of CVD: evidence for sex-specific differences.  Atherosclerosis. 2007;  190 416-422
  • 26 Sandhofer A, Iglseder B, Paulweber B, Ebenbichler CF, Patsch JR. Comparison of different definitions of the metabolic syndrome.  Eur J Clin Invest. 2007;  37 109-116
  • 27 Sipila K, Koivistoinen T, Moilanen L, Nieminen T, Reunanen A, Jula A, Salomaa V, Kaaja R, Koobi T, Kukkonen-Harjula K, Majahalme S, Kahonen M. Metabolic syndrome and arterial stiffness: the Health 2000 Survey.  Metabolism. 2007;  56 320-326
  • 28 Katz R, Wong ND, Kronmal R, Takasu J, Shavelle DM, Probstfield JL, Bertoni AG, Budoff MJ, O'Brien KD. Features of the metabolic syndrome and diabetes mellitus as predictors of aortic valve calcification in the Multi-Ethnic Study of Atherosclerosis.  Circulation. 2006;  113 2113-2119
  • 29 Yoshikawa R, Wada J, Seiki K, Matsuoka T, Miyamoto S, Takahashi K, Ota S, Taniai K, Hida K, Yamakado M, Shikata K, Uehara Y, Urade Y, Makino H. Urinary PGDS levels are associated with vascular injury in type 2 diabetes patients.  Diabetes Res Clin Pract. 2007;  76 358-367
  • 30 Bonadonna RC, Cucinotta D, Fedele D, Riccardi G, Tiengo A. The metabolic syndrome is a risk indicator of microvascular and macrovascular complications in diabetes: results from Metascreen, a multicenter diabetes clinic-based survey.  Diabetes Care. 2006;  29 2701-2707
  • 31 Milionis HJ, Kostapanos MS, Liberopoulos EN, Goudevenos J, Athyros VG, Mikhailidis DP, Elisaf MS. Different definitions of the metabolic syndrome and risk of first-ever acute ischaemic non-embolic stroke in elderly subjects.  Int J Clin Pract. 2007;  61 545-551
  • 32 Bataille V, Perret B, Dallongeville J, Arveiler D, Yarnell J, Ducimetiere P, Ferrieres J. Metabolic syndrome and coronary heart disease risk in a population-based study of middle-aged men from France and Northern Ireland. A nested case-control study from the PRIME cohort.  Diabetes Metab. 2006;  32 475-479
  • 33 Assmann G, Guerra R, Fox G, Cullen P, Schulte H, Willett D, Grundy SM. Harmonizing the definition of the metabolic syndrome: comparison of the criteria of the Adult Treatment Panel III and the International Diabetes Federation in United States American and European populations.  Am J Cardiol. 2007;  99 541-548
  • 34 Qiao Q. Comparison of different definitions of the metabolic syndrome in relation to cardiovascular mortality in European men and women.  Diabetologia. 2006;  49 2837-2846
  • 35 Katzmarzyk PT, Janssen I, Ross R, Church TS, Blair SN. The importance of waist circumference in the definition of metabolic syndrome: prospective analyses of mortality in men.  Diabetes Care. 2006;  29 404-409
  • 36 Lawlor DA, Smith GD, Ebrahim S. Does the new International Diabetes Federation definition of the metabolic syndrome predict CHD any more strongly than older definitions? Findings from the British Women's Heart and Health Study.  Diabetologia. 2006;  49 41-48
  • 37 Nilsson PM, Engstrom G, Hedblad B. The metabolic syndrome and incidence of cardiovascular disease in non-diabetic subjects-a population-based study comparing three different definitions.  Diabet Med. 2007; 24: 464-472; 
  • 38 Lorenzo C, Williams K, Hunt KJ, Haffner SM. The National Cholesterol Education Program - Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes.  Diabetes Care. 2007;  30 8-13
  • 39 Wang J, Ruotsalainen S, Moilanen L, Lepisto P, Laakso M, Kuusisto J. The metabolic syndrome predicts cardiovascular mortality: a 13-year follow-up study in elderly non-diabetic Finns.  Eur Heart J. 2007;  28 857-864
  • 40 Lee J, Ma S, Heng D, Tan CE, Chew SK, Hughes K, Tai ES. Should central obesity be an optional or essential component of the metabolic syndrome? Ischemic heart disease risk in the Singapore Cardiovascular Cohort Study.  Diabetes Care. 2007;  30 343-347
  • 41 Empana JP, Duciemetiere P, Balkau B, Jouven X. Contribution of the metabolic syndrome to sudden death risk in asymptomatic men the Paris Prospective Study I.  Eur Heart J. 2007; 18: 1149-1154; 
  • 42 Meigs JB, Rutter MK, Sullivan LM, Fox CS, D’Agostino RB, Wilson PW. Impact of insulin resistance on risk of type 2 diabetes and cardiovascular disease in people with metabolic syndrome.  Diabetes Care. 2007; 30: 1219-1225; 
  • 43 Simone G de, Devereux RB, Chinali M, Best LG, Lee ET, Galloway JM, Resnick HE. Prognostic impact of metabolic syndrome by different definitions in a population with high prevalence of obesity and diabetes. The Strong Heart Study.  Diabetes Care. 2007; 30: 1851-1856; 
  • 44 Pambianco G, Costacou T, Orchard TJ. The prediction of major outcomes of type 1 diabetes. A 12 year prospective evaluation of three separate definitions of the metabolic syndrome, and their components and estimated glucose disposal rate: The Pittsburgh Epidemiology of diabetes complications study experience.  Diabetes Care. 2007; 30: 1248-1254; 
  • 45 Kilpatrick ES, Rigby AS, Atkin SL. Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: “double diabetes”; in the Diabetes Control and Complications Trial.  Diabetes Care. 2007;  30 707-712
  • 46 Sone H, Tanaka S, Ishibashi S, Yamasaki Y, Oikawa S, Ito H, Saito Y, Ohashi Y, Akanuma Y, Yamada N. The new worldwide definition of metabolic syndrome is not a better diagnostic predictor of cardiovascular disease in Japanese diabetic patients than the existing definitions: additional analysis from the Japan Diabetes Complications Study.  Diabetes Care. 2006;  29 145-147
  • 47 Sone H, Mizuno S, Fujii H, Yoshimura Y, Yamasaki Y, Ishibashi S, Katayama S, Saito Y, Ito H, Ohashi Y, Akanuma Y, Yamada N. Is the diagnosis of metabolic syndrome useful for predicting cardiovascular disease in asian diabetic patients? Analysis from the Japan Diabetes Complications Study.  Diabetes Care. 2005;  28 1463-1471
  • 48 Monami M, Marchionni N, Masotti G, Mannucci E. IDF and ATP-III definitions of metabolic syndrome in the prediction of all-cause mortality in type 2 diabetic patients.  Diabetes Obes Metab. 2007;  9 350-353
  • 49 Tong PC, Kong AP, So WY, Yang X, Ho CS, Ma RC, Ozaki R, Chow CC, Lam CW, Chan JC, Cockram CS. The usefulness of the International Diabetes Federation and the National Cholesterol Education Program's Adult Treatment Panel III definitions of the Metabolic Syndrome in Predicting Coronary Heart Disease in Subjects with Type 2 Diabetes Mellitus.  Diabetes Care. 2007; 30: 1206-1211; 
  • 50 Boulon C, Lafitte M, Richeboeuf V, Paviot B, Pradeau V, Coste P, Bonnet J, Couffinhal T. Prevalence of metabolic syndrome after acute coronary syndrome and its prognostic significance.  Am J Cardiol. 2006;  98 1429-1434
  • 51 Saely CH, Koch L, Schmid F, Marte T, Aczel S, Langer P, Hoefle G, Drexel H. Adult Treatment Panel III 2001 but not International Diabetes Federation 2005 criteria of the metabolic syndrome predict clinical cardiovascular events in subjects who underwent coronary angiography.  Diabetes Care. 2006;  29 901-907
  • 52 Go AS, Chertow GM, Fan D, MacCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.  N Engl J Med. 2004;  351 1296-1305
  • 53 Kitiyakara C, Yamwong S, Cheepudomwit S, Domrongkitchaiporn S, Unkurapinun N, Pakpeankitvatana V, Sritara P. The metabolic syndrome and chronic kidney disease in a Southeast Asian cohort.  Kidney Int. 2007;  71 693-700
  • 54 Wang JJ, Li HB, Kinnunen L, Hu G, Jarvinen TM, Miettinen ME, Yuan S, Tuomilehto J. How well does the metabolic syndrome defined by five definitions predict incident diabetes and incident coronary heart disease in a Chinese population?.  Atherosclerosis. 2007; 192: 161-168; 
  • 55 Cheung BM, Wat NM, Man YB, Tam S, Thomas GN, Leung GM, Cheng CH, Woo J, Janus ED, Lau CP, Lam TH, Lam KS. Development of Diabetes in Chinese with the Metabolic Syndrome - a Six Year Prospective Study.  Diabetes Care. 2007; 30: 1430-1436; 
  • 56 Hanley AJ, Karter AJ, Williams K, Festa A, D’Agostino RB, Wagenknecht LE, Haffner SM. Prediction of type 2 diabetes mellitus with alternative definitions of the metabolic syndrome: the Insulin Resistance Atherosclerosis Study.  Circulation. 2005;  112 3713-3721
  • 57 Mannucci E, Monami M, Cresci B, Pala L, Bardini G, Petracca MG, Dicembrini I, Pasqua A, Buiatti E, Rotella CM. National Cholesterol Education Program and International Diabetes Federation definitions of metabolic syndrome in the prediction of diabetes. Results from the FIrenze-Bagno A Ripoli study.  Diabetes Obes Metab. 2007 (epub ahead of print); 

1 C. H. Saely and P. Rein contributed equally to this work.

Correspondence

H. DrexelMD 

Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT)

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Austria

Phone: +43/5522/303 26 70

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