Diabetes and Metabolism Journal

Korean Diabetes Association (대한당뇨병학회)
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Comparison of the Predictability of Cardiovascular Disease Risk According to Different Metabolic Syndrome Criteria of American Heart Association/National Heart, Lung, and Blood Institute and International Diabetes Federation in Korean Men

한국인 남성에서 American Heart Association/National Heart, Lung, and Blood Institute와 International Diabetes Federation 대사증후군 진단 기준에 따른 심혈관질환 예측률의 비교

Lee, Do-Young;Rhee, Eun-Jung;Choi, Eun-Suk;Kim, Ji-Hoon;Won, Jong-Chul;Park, Cheol-Young;Lee, Won-Young;Oh, Ki-Won;Park, Sung-Woo;Kim, Sun-Woo
이도영;이은정;최은숙;김지훈;원종철;박철영;이원영;오기원;박성우;김선우

  • Published : 2008.08.01
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Abstract

Background: We compared the prevalences of two criteria of metabolic syndrome, that is, American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) and International Diabetes Federation (IDF), in Korean male adults and compared the predictability of insulin resistance and future cardiovascular diseases using Framingham Risk Score. Methods: In total 23,467 male adults (mean age 43.3 years) who participated in medical check-up in 2005, the prevalences of metabolic syndrome according to AHA/NHLBI and IDF criteria and the presence of insulin resistance, defined by the highest quartile of Homeostasis Model Assessment of insulin resistance index (HOMA-IR), were compared. The relative risk (calculated risk/average risk) for 10-year risk for coronary artery disease (CHD) assessed by Framingham Risk Score were compared. Results: 5.8% of the subjects had diabetes mellitus. 20.7% and 13.2%of the subjects had metabolic syndrome defined by AHA/NHLBI and IDF criteria, and the two criteria showed high agreement with kappa value of 0.737 (P < 0.01). More subjects in IDF-defined group had insulin resistance compared with AHA/NHLBI definition (59.8 vs. 54%, P < 0.01). The odds ratio for increased relative risk (> 1.0) for 10-year CHD were higher in AHA/NHLBI-defined subjects compared with IDF-defined subject (3.295 vs. 3.082). The Kappa values for the analysis of agreement between each criteria and prediction of insulin resistance or cardiovascular disease risk, were too low for comparison. Conclusion: In Korean males, the prevalence for metabolic syndrome defined by AHA/NHLBI criteria was higher than those defined by IDF criteria. IDF criteria detected more subjects with insulin resistance, but didn't have better predictability for CHD compared with AHA/NHLBI criteria. (KOREAN DIABETES J 32:317-327, 2008)

연구배경: 한국인 성인 남성에서, American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) 진단기준과 International Diabetes Federation (IDF) 진단기준에 의한 대사증후군의 유병률을 비교하고, 인슐린저항성과, Framingham Risk Score를 이용한 10년 관상동맥질환의 발병위험도를 분석하여 진단기준의 차이를 알아보았다. 방법: 2005년 종합검진센터에서 검진을 시행받은 23,467 명의 남성 (평균 연령 43.4세)을 대상으로 분석하였으며, AHA/NHLBI 진단기준과 IDF 진단기준에 의한 유병률을 비교하였으며, Homeostasis Model Assessment of insulin resistance index (HOMA-IR)의 최상 4분위 이상으로 정의 된 인슐린저항성 여부를 각 진단기준에 의해 진단된 대사증 후군에서 유병률을 비교하였으며, Framingham Risk Score 를 이용하여 10년 관상동맥질환 발병의 상대위험도 (계산된 위험도/평균위험도)를 비교하였다. 결과: 전체 대상자 중 당뇨병이 있는 대상은 5.8%였으 며, AHA/NHLBI 기준에 해당하는 대사증후군은 20.7%, IDF 기준은 13.2%였고, 두 진단기준은 kappa값이 0.737 (P < 0.01)으로 높은 일치도를 보였다. IDF 진단기준에 의해서 대사증후군으로 진단된 군에서 AHA/NHLBI에 의해서 진 단된 대사증후군보다 인슐린저항성이 더 많이 관찰되었고 (59.8 vs. 54.0%, P < 0.01), 10년 관상동맥질환 발병의 상 대위험도가 1.0보다 높을 (> 1.0) 교차비는 AHA/ NHLBI 진단기준이 IDF에 의해 정의된 대상군에서 더 높았다 (3.295 vs. 3.082). 인슐린저항성 여부나 심혈관질환 위험도 를 예측하는 정도와 각 진단기준의 일치도는 너무 낮아서 분석이 어려웠다. 결론: 한국인 성인 남성에서, AHA/NHLBI 진단기준의 대사증후군 유병률이 IDF보다 더 높게 분석되었으며, IDF 진단기준은, 인슐린저항성이 있는 대상을 더 많이 진단하였 으나, AHA/NHBLI 진단기준보다는 심혈관질환을 예측하는 데에는 더 효율적이지 않았다.

Keywords

References

  1. Meigs JB: Definitions and mechanisms of the metabolic syndrome. Curr Opin Endocrinol Diabetes 13:103-10, 2006
  2. World Health Organization 1999: Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation 1999
  3. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: 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 285:2487-86, 2001
  4. Grundy SM: Metabolic syndrome scientific statement by the American Heart Association and the National Heart, Lung, and Blood Institute. Arterioscler Thromb Vasc Biol 25:2243-4, 2005 https://doi.org/10.1161/01.ATV.0000189155.75833.c7
  5. Lackland DT, Orchard TJ, Keil JE, Saunders DE Jr, Wheeler FC, Adams-Campbell LL, McDonald RH, Knapp RG: Are race differences in the prevalence of hypertension explained by body mass and fat distribution? A survey in a biracial population. Int J Epidemiol 21:236-45, 1992 https://doi.org/10.1093/ije/21.2.236
  6. Tan CE, Ma S, Wai D, Chew SK, Tai ES: Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians? Diabetes Care 27:1182-6, 2004 https://doi.org/10.2337/diacare.27.5.1182
  7. Lee WY, Park JS, Noh SY, Rhee EJ, Kim SW, Zinnet PZ: Prevalence of the metabolic syndrome among 40,698 Korean metropolitan subjects. Diabetes Res Clin Pract 65:143-9, 2004 https://doi.org/10.1016/j.diabres.2003.12.007
  8. Western Pacific Regional Office of the World Health Organization, The International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. 2000
  9. Stern MP, Williams K, González-Villalpando C, Hunt KJ, Haffner SM: Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease? Diabetes Care 27:2676-81, 2004 https://doi.org/10.2337/diacare.27.11.2676
  10. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 288: 2709-16, 2002 https://doi.org/10.1001/jama.288.21.2709
  11. International Diabetes Federation: The IDF consensus worldwide definition of the metabolic syndrome. 2005. http://www.idf.org
  12. Ford ES: Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. Diabetes Care 28:2745-9, 2005 https://doi.org/10.2337/diacare.28.11.2745
  13. 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 99:541-8, 2007 https://doi.org/10.1016/j.amjcard.2006.08.045
  14. Pan WH, Yeh WT, Weng LC: Epidemiology of metabolic syndrome in Asia. Asia Pac J Clin Nutr 17(Suppl 1):37-42, 2008
  15. Lee CM, Huxley RR, Woodward M, Zimmet P, Shaw J, Cho NH, Kim HR, Viali S, Tominaga M, Vistisen D, Borch-Johnsen K, Colagiuri S: Detect-2 Collaboration: Comparisons of metabolic syndrome definitions in four populations of the Asia-Pacific region. Metab Syndr Relat Disord 6:37-46, 2008 https://doi.org/10.1089/met.2007.0024
  16. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, Kim DY, Kwon HS, Kim SR, Lee CB, Oh SJ, Park CY, Yoo HJ: Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract 75:72-80, 2007 https://doi.org/10.1016/j.diabres.2006.04.013
  17. Kim Y, Suh YK, Choi H: BMI and metabolic disorders in South Korean adults: 1998 Korea National Health and Nutrition Survey. Obes Res 12:445-53, 2004 https://doi.org/10.1038/oby.2004.50
  18. Lim S, Park KS, Lee HK, Cho SI: Korean National Health and Nutrition Examination Surveys: Changes in the characteristics of metabolic syndrome in Korea over the period 1998-2001 as determined by Korean National Health and Nutrition Examination Surveys. Diabetes Care 28:1810-2, 2005 https://doi.org/10.2337/diacare.28.7.1810
  19. Park HS, Kim SM, Lee JS, Lee J, Han JH, Yoon DK, Baik SH, Choi DS, Choi KM: Prevalence and trends of metabolic syndrome in Korea: Korean National Health and Nutrition Survey 1998-2001. Diabetes Obes Metab 9:50-8, 2007 https://doi.org/10.1111/j.1463-1326.2005.00569.x
  20. Kim HM, Kim DJ, Jung IH, Park C, Park J: Prevalence of the metabolic syndrome among Korean adults using the new International Diabetes Federation definition and the new abdominal obesity criteria for the Korean people. Diabetes Res Clin Pract 77:99-106, 2007 https://doi.org/10.1016/j.diabres.2006.10.009
  21. Choi KM, Kim SM, Kim YE, Choi DS: Prevalence and cardiovascular disease risk of the metabolic syndrome using National Cholesterol Education Program and International Diabetes Federation definitions in the Korean population. Metabolism Clinical and Experimental 56:552-8, 2007 https://doi.org/10.1016/j.metabol.2006.12.003
  22. 남옥연, 이성희, 강재헌, 김철환, 김성걸: 정상 성인 남성에서의 대사증후군과 인슐린 저항성과의 관련성: IDF 새로운 진단기준과 NCEP-ATP III 진단기준 적용. 가정의학회지 27:807-14, 2006
  23. 원종철, 박중열, 송기호, 이우제, 고은희, 남궁일성, 한성민, 이무송, 김민선, 이기업: 정읍지역 주민에서 수정된 National Cholesterol Education Program과 International Diabetes Federation의 진단기준에 따른 대사증후군 유병율의 변화. 당뇨병 31:284-92, 2007 https://doi.org/10.4093/jkda.2007.31.3.284
  24. List of NGSP Certified Methods. Available at http://www.missouri.edu/-diabetes/ngsp.html Last accessed in July, 2007
  25. Schwartz KL, Monsur JC, Bartoces MG, West PA, Neale AV: Correlation of same-visit HbA1c test with laboratory-based measurements: a MetroNet study. BMC Fam Pract 6:28, 2005 https://doi.org/10.1186/1471-2296-6-28
  26. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412-9, 1985 https://doi.org/10.1007/BF00280883
  27. Onat A, Hergenç G, Türkmen S, Yazici M, Sari I, Can G: Discordance between insulin resistance and metabolic syndrome: features and associated cardiovascular risk in adults with normal glucose regulation. Metabolism 55:445-52, 2006 https://doi.org/10.1016/j.metabol.2005.10.005
  28. Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Meigs JB, Bonadonna RC, Muggeo M: Insulin resistance as estimated by homeostasis model assessment predicts incident symptomatic cardiovascular disease in caucasian subjects from the general population: the Bruneck study. Diabetes Care 30:318-24, 2007 https://doi.org/10.2337/dc06-0919
  29. Perry IJ, Villegas R, Salim A, Flynn A: Clustering of protective factors for glucose intolerance and insulin resistance: a cross-sectional study. Diabet Med 22:1091-7, 2005 https://doi.org/10.1111/j.1464-5491.2005.01617.x
  30. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB: Prediction of coronary heart disease using risk factor categories. Circulation 97:1837-47, 1998 https://doi.org/10.1161/01.CIR.97.18.1837
  31. Landis JR, Koch GG: The measurement of observer agreement for categories. Biometrics 33:159-74, 1977 https://doi.org/10.2307/2529310
  32. 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 26:3153-9, 2003 https://doi.org/10.2337/diacare.26.11.3153
  33. Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults.: Findings from the third National Health and Nutrition Examination Survey. JAMA 287:356-9, 2002 https://doi.org/10.1001/jama.287.3.356
  34. Yajnik CS, Yudkin JS: The Y-Y paradox. Lancet 363:163, 2004 https://doi.org/10.1016/S0140-6736(03)15269-5
  35. Report on 2001 National Health and Nutrition Survey: Ministry of Health and Social Welfare Gyeonggi-do;2002
  36. Park HS, Kim SM, Lee JS, Lee J, Han JH, Yoon DK, Baik SH, Choi DS, Choi KM: Prevalence and trends of metabolic syndrome in Korea: Korean National Health and Nutrition Survey 1998-2001. Diabetes Obes Metab 9:50-8, 2007 https://doi.org/10.1111/j.1463-1326.2005.00569.x
  37. Park HS, Lee SY, Kim SM, Han JH, Kim DJ: Prevalence of the metabolic syndrome among Korean adults according to the criteria of the International Diabetes Federation. Diabetes Care 29:933-4, 2006 https://doi.org/10.2337/diacare.29.04.06.dc06-0069
  38. Park SH, Lee WY, Rhee EJ, Jeon WK, Kim BI, Ryu SH, Kim SW: Relative risks of the metabolic syndrome according to the degree of insulin resistance in apparently healthy Korean adults. Clin Sci 108:553-9, 2005 https://doi.org/10.1042/CS20040331
  39. Lee WY, Park JS, Noh SY, Rhee EJ, Kim SW, Zimmet PZ: Prevalence of the metabolic syndrome among 40,698 Korean metropolitan subjects. Diabetes Res Clin Pract 65:143-9, 2004 https://doi.org/10.1016/j.diabres.2003.12.007
  40. Lee WY, Jung CH, Park JS, Rhee EJ, Kim SW: Effects of smoking, alcohol, exercise, education, and family history on the metabolic syndrome as defined by the ATP III. Diabetes Res Clin Pract 67:70-7, 2005 https://doi.org/10.1016/j.diabres.2004.05.006
  41. 1998Cirera L, Tormo MJ, Chirlaque MD, Navarro C: Cardiovascular risk factors and educational attainment in Southern Spain: a study of a random sample of 3091 adults. Eur J Epidemiol 14:755-63, 1998 https://doi.org/10.1023/A:1007596222217
  42. Park HS, Park CY, Oh SW, Yoo HJ: Prevalence of obesity and metabolic syndrome in Korean adults. Obes Rev 9:104-7, 2008
  43. Girman CJ, Rhodes T, Mercuri M, Pyorala K, Kjekshus J, Pedersen TR, Beere PA, Gotto AM, Clearfield M: 4S Group and the AFCAPS/TexCAPS Research Group: The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). Am J Cardiology 93:136 -41, 2004 https://doi.org/10.1016/j.amjcard.2003.09.028
  44. Wilson PW, D'Agostino RB, Parise H, Sullivan L: Metabolic Syndrome as a Precursor of Cardiovascular Disease and Type 2 Diabetes Mellitus. Circulation 112:3066-72, 2005 https://doi.org/10.1161/CIRCULATIONAHA.105.539528
  45. Sattar N, Gaw A, Scherbakova O, Ford I, O'Reilly DS, Haffner SM, Isles C, MacFarlane PW, Packard CJ, Cobbe SM, Shepherd J: Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 108:414-9, 2003 https://doi.org/10.1161/01.CIR.0000080897.52664.94
  46. Ford ES: Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 28:1769-78, 2005 https://doi.org/10.2337/diacare.28.7.1769
  47. Hanson RL. Imperatore G, Bennett PH, Knowler WC: Components of the 'metabolic syndrome' and incidence of type 2 diabetes. Diabetes 51:3120-7, 2002 https://doi.org/10.2337/diabetes.51.10.3120
  48. Resnick HE, Jones K, Ruotolo G, Jain AK, Henderson J, Lu W, Howard BV: Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease in nondiabetic American Indians : the strong heart study. Diabetes Care 26:861-7, 2003 https://doi.org/10.2337/diacare.26.3.861
  49. Stern MP, Williams K, González-Villalpando C, Hunt KJ, Haffner SM: Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease? Diabetes Care 27:2676-81, 2004 https://doi.org/10.2337/diacare.27.11.2676
  50. Klein BE, Klein R, Lee KE: Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in Beaver Dam. Diabetes Care 25: 1790-4, 2002 https://doi.org/10.2337/diacare.25.10.1790
  51. Hanley AJ, Karter AJ, Williams K, Festa A, D'Agostino RB Jr, Wagenknecht LE, Haffner SM: Prediction of type 2 diabetes mellitus with alternative definitions of the metabolic syndrome: the insulin resistance atherosclerosis study. Circulation 112: 3713-21, 2005 https://doi.org/10.1161/CIRCULATIONAHA.105.559633
  52. 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 30:8-13, 2007 https://doi.org/10.2337/dc06-1414
  53. 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. Diabetic Medicine 24:464-72, 2007 https://doi.org/10.1111/j.1464-5491.2007.02142.x
  54. 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 29:901-7, 2006 https://doi.org/10.2337/diacare.29.04.06.dc05-2011
  55. Liu J, Hong Y, D'Agostino RB Sr, Wu Z, Wang W, Sun J, Wilson PW, Kannel WB, Zhao D: Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese Multi-Provincial Cohort Study. JAMA 291:2591-9, 2004 https://doi.org/10.1001/jama.291.21.2591
  56. Wu Y, Liu X, Li X, Li Y, Zhao L, Chen Z, Li Y, Rao X, Zhou B, Detrano R, Liu K: USA-PRC Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology Research Group; China Multicenter Collaborative Study of Cardiovascular Epidemiology Research Group: Estimation of 10-year risk of fatal and nonfatal ischemic cardiovascular diseases in Chinese adults. Circulation 114:2217-25, 2006 https://doi.org/10.1161/CIRCULATIONAHA.105.607499
  57. Bhopal R, Fischbacher C, Vartiainen E, Unwin N, White M, Alberti G: Predicted and observed cardiovascular disease in South Asians: application of FINRISK, Framingham and SCORE models to Newcastle Heart Project data. J Public Health (Oxf) 27:93-100, 2005 https://doi.org/10.1093/pubmed/fdh202