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Multicenter Study
. 2018 Jan 19;17(1):17.
doi: 10.1186/s12933-017-0647-y.

Metabolic syndrome severity is significantly associated with future coronary heart disease in Type 2 diabetes

Matthew J Gurka  1 , Yi Guo  1 , Stephanie L Filipp  1 , Mark D DeBoer  2
Affiliations
Multicenter Study

Metabolic syndrome severity is significantly associated with future coronary heart disease in Type 2 diabetes

Matthew J Gurka et al. Cardiovasc Diabetol. .

Abstract

Background: 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.

Objective: 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.

Methods: 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).

Results: 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).

Conclusions: 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.

Keywords: Cardiovascular disease; Diabetes; Metabolic syndrome; Risk.

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Figures

Fig. 1
Fig. 1
Standard- and no-glucose MetS severity Z-scores by timing of diabetes diagnosis. 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
Fig. 2
Fig. 2
Standard MetS severity Z-scores by sex and race. Model-generated values of MetS severity for a white males, b white females, c black males, and d black females 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 as a covariate
Fig. 3
Fig. 3
Standard MetS severity Z-scores by sex and race. Cox-regression analysis of time from diabetes diagnosis to diagnosis of coronary heart disease (CHD) for participants with a standard and b no-glucose MetS severity Z-scores of 0, 0.5, 1 and 1.5. Models were stratified by site and included age (at baseline), sex, and race as covariates
See this image and copyright information in PMC

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