The online version of this article (https://doi.org/10.1186/s12933-017-0647-y) contains supplementary material, which is available to authorized users.
The severity of the metabolic syndrome (MetS) is significantly associated with future coronary heart disease (CHD) among individuals without baseline Type 2 diabetes. However, the validity of assessing MetS severity among individuals with diabetes is unknown.
To assess for differences in MetS severity by timing of Type 2 diabetes diagnosis and to assess for associations between MetS severity and future CHD among individuals with diabetes.
We analyzed data from participants of the Atherosclerosis Risk in Communities study, including 1419 with- and 7241 without diabetes, followed during 4 visits and adjudicated CHD diagnoses over a 20-year period. We used Cox-regression techniques to assess hazard ratios (HR) of CHD based on a sex- and race/ethnicity-specific MetS-severity Z-score (standard MetS score) and a similar MetS-severity score formulated without incorporating glucose as a component of MetS (no-glucose MetS score).
For both the standard- and no-glucose MetS-severity scores, scores were highest in the baseline-diabetes group, lowest in the never-diabetes group and intermediate in the incident-diabetes groups. Among participants with diabetes, increasing MetS-severity score at baseline was associated with incident CHD, using both the standard MetS score (HR 1.29, 95% confidence interval [CI] 1.21, 1.39) and the no-glucose score (HR 1.42, CI 1.24, 1.62) (both p < 0.001). For the baseline-diabetes group, this relationship remained significant when Visit 2 Hemoglobin-A1c was included in the model, both for the standard MetS score (HR 1.21, CI 1.09, 1.34; p < 0.001) and the no-glucose score (HR 1.25, CI 1.04, 1.51; p = 0.02).
MetS severity appears to provide an estimate of metabolic disarray in the setting of diabetes and is predictive of future CHD events beyond HbA1c. Identifying MetS severity among individuals with diabetes may help in identifying those at higher risk, who could then receive further preventative treatment.
Additional file 1: Figure S1. Levels of the individual MetS components by timing of diabetes diagnosis. Model-generated values of A). waist circumference, B). systolic blood pressure, C). HDL-cholesterol, D). fasting triglycerides, and E). fasting glucose for participants with diabetes at baseline (Visit 1), and those diagnosed by Visits 2, 3, and 4, compared to those never diagnosed. All models were stratified by site and included age (at baseline), sex, and race as covariates. Figure S2. No-glucose MetS severity Z-scores by sex and race. Model-generated values for A). standard and B). no-glucose MetS severity Z-scores for participants with diabetes at baseline (Visit 1), and those diagnosed by Visits 2, 3, and 4, compared to those never diagnosed. All models were stratified by site and included age (at baseline), sex, and race as covariates.
Additional file 2: Table S1. Models of MetS (and MetS severity) in individuals with diabetes on incident CHD. Table S2. Models of MetS (and MetS severity) in individuals with diabetes on incident CHD by time of diabetes diagnosis. Table S3. Models of standard MetS severity in individuals with baseline diabetes on incident CHD with and without inclusion of HbA1c at Visit 2.
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- Metabolic syndrome severity is significantly associated with future coronary heart disease in Type 2 diabetes
Matthew J. Gurka
Stephanie L. Filipp
Mark D. DeBoer
- BioMed Central
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