Assessing Baseline and Temporal Changes in Cardiometabolic Risk Using Metabolic Syndrome Severity and Common Risk Scores

Abstract

Background Type 2 diabetes mellitus (T2 DM ) is considered a cardiovascular disease ( CVD ) risk equivalent, thereby linking assessment of cardiometabolic risk with that of CVD risk over time. Our goal was to determine how commonly used CVD risk scores and metabolic syndrome (MetS) severity performed in predicting T2 DM with and without ultimate CVD . Methods and Results We assessed data from 8273 participants of the ARIC (Atherosclerosis Risk in Communities) Study, using the pooled cohort atherosclerotic CVD risk score, the Framingham Risk Score, and a MetS severity Z score to assess their association with future risk for CVD alone, T2 DM alone, or both over 20 years of follow-up. Baseline levels of all scores were significantly associated with isolated incident T2 DM (odds ratios [ OR s] for each 1- SD increase: atherosclerotic CVD =1.7, Framingham risk score=1.7, MetS Z score=5.1). All 3 baseline scores were also significantly associated with isolated incident CVD (atherosclerotic CVD OR =2.4, Framingham risk score OR =2.3, MetS Z-score OR =1.8), with the 2 CVD scores remaining significant independent of MetS severity. MetS severity was strongly associated with future T2 DM leading to CVD (MetS Z-score OR =7.0, atherosclerotic CVD OR =3.9, Framingham risk score OR =3.5). Furthermore, changes in MetS severity were independently associated with future T2 DM - CVD progression. Conclusions CVD risk scores are associated with risk for future isolated T2 DM in addition to isolated CVD . However, MetS severity (both baseline and changes over time) was more strongly associated with T2 DM , including T2 DM ultimately leading to CVD . Following MetS severity within patients over time may identify those at greatest risk of combined cardiometabolic disease.

Keywords: cardiovascular disease; metabolic syndrome; prediction; type 2 diabetes mellitus.

Figure 1

Incident disease progression classifications (after visit 2). Participants were categorized by timing of diagnosis of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), with “early” diagnosis corresponding to that found during visits 2 to 4 (3–10 years of follow‐up) and “late” diagnosis occurring after visit 4 (10–22 years of follow‐up). T2DM ascertainment was only available through the early period of the ARIC (Atherosclerosis Risk in Communities) Study.

Figure 2

Mean baseline scores and change in scores between visit 1 and visit 2 by disease category. Scores (mean [95% confidence interval {CI}]) for metabolic syndrome (MetS) severity Z score, atherosclerotic cardiovascular disease (ASCVD) pooled cohort score, and Framingham risk score by ultimate disease diagnosis category are shown for baseline visit and changes in scores from visit 2 to visit 1 (V2–V1), adjusted for visit 1. Early CVD=incident disease between visit 2 and visit 4 (between ≈3 and ≈9 years after visit 1); late CVD=incident adjudicated CVD event after visit 4 (>≈9 years after visit 1). T2DM indicates type 2 diabetes mellitus.