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. 2014 Jan;22(1):110-8.
doi: 10.1002/oby.20585. Epub 2013 Sep 5.

The progression of cardiometabolic disease: validation of a new cardiometabolic disease staging system applicable to obesity

Fangjian Guo  1 , Douglas R Moellering, W Timothy Garvey
Affiliations

The progression of cardiometabolic disease: validation of a new cardiometabolic disease staging system applicable to obesity

Fangjian Guo et al. Obesity (Silver Spring). 2014 Jan.

Abstract

Objective: To validate a Cardiometabolic Disease Staging (CMDS) system for assigning risk level for diabetes, and all-cause and cardiovascular disease (CVD) mortality.

Design and methods: Two large national cohorts, CARDIA and NHANES III, were used to validate CMDS. CMDS: Stage 0: metabolically healthy; Stage 1: one or two metabolic syndrome risk factors [other than impaired fasting glucose (IFG)]; Stage 2: IFG or impaired glucose tolerance (IGT) or metabolic syndrome (without IFG); Stage 3: two of three (IFG, IGT, and/or metabolic syndrome); and Stage 4: type 2 diabetes mellitus/CVD.

Results: In the CARDIA study, compared with Stage 0 metabolically healthy subjects, adjusted risk for diabetes exponentially increased from Stage 1 [hazard ratio (HR) 2.83, 95% confidence interval (CI): 1.76-4.55], to Stage 2 (HR 8.06, 95% CI 4.91-13.2), to Stage 3 (HR 23.5, 95% CI 13.7-40.1) (P for trend <0.001). In NHANES III, both cumulative incidence and multivariable adjusted HRs markedly increased for both all-cause and CVD mortality with advancement of the risk stage from Stages 0 to 4. Adjustment for body mass index (BMI) minimally affected the risks for diabetes and all-cause/CVD mortality using CMDS.

Conclusion: CMDS can discriminate a wide range of risk for diabetes, CVD mortality, and all-cause mortality independent of BMI, and should be studied as a risk assessment tool to guide interventions that prevent and treat cardiometabolic disease.

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Conflict of interest statement

Conflicts of Interest

Dr. Garvey is an advisor for Alkermes, Plc., Daiichi-Sankyo, Inc., LipoScience, VIVUS, Inc., Janssen Pharmaceuticals, and Tethys; is a speaker for Merck; and is a stockholder for Bristol-Myers Squibb Company, Isis/Genzyme, Merck, Pfizer, Inc., Eli Lilly and Company, and VIVUS, Inc. He has received research support from Amylin Pharmaceuticals, Inc., Merck & Co., and Weight Watchers International, Inc.

Figures

Figure 1
Figure 1
A. Cumulative diabetes incidence according to risk staging system. B, C. Adjusted hazard ratios for incident diabetes. Model 1 adjusted for age, sex, race, income, education, current smoker, current alcohol drinker and parent diabetes history. Model 2 additionally adjusted for BMI.
Figure 2
Figure 2
A. Kaplan-Meier plots for all-cause mortality according to risk staging system. B, C. Adjusted hazard ratios for all-cause mortality for risk staging system. Model 1 adjusted for age, sex, race, income, education, current smoker, current alcohol drinker, and model 2 additionally adjusted for BMI.
Figure 3
Figure 3
A. Kaplan-Meier plots for CVD mortality according to risk staging system. B, C. Adjusted hazard ratios for CVD mortality for risk staging system. Model 1 adjusted for age, sex, race, income, education, current smoker, current alcohol drinker, and model 2 additionally adjusted for BMI.
See this image and copyright information in PMC

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