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DOI: 10.1055/s-2008-1065332
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York
Relationship Between Metabolic Syndrome and its Components with Coronary Heart Disease in Iranian Men and Women
Publication History
received 20.08.2007
first decision 23.01.2008
accepted 22.02.2008
Publication Date:
01 April 2008 (online)
Abstract
Introduction: Although metabolic syndrome (MetS) is receiving increased attention from physicians, data on the syndrome's association with coronary heart disease (CHD) in Iranian populations are limited.
Materials and Methods: To estimate the odds ratio (OR) of MetS defined by each of the International Diabetes Federation (IDF), the Adult Treatment Panel (ATPIII) and the WHO definitions for CHD, logistic regression analysis was used on 5981 subjects aged≥30 years, in both sexes in 3 models; model 1 an age adjusted model, model 2 adjusted for age, smoking status, premature history of CHD and LDL cholesterol and model 3 adjusted for mentioned variables plus the MetS components.
Results: The MetS defined by all the three definitions was associated with CHD in models 1 and 2.The relatively highest odds ratio (95% CI) of the MetS for CHD was defined in model 2 by WHO definition in men (2.3 (1.8–3)) and the ATPIII definition in women (1.6 (1.3–2)). In model 3, MetS lost its association with CHD; in men however, high fasting plasma glucose and high blood pressure (plus obesity by the WHO definition) and in women, high blood pressure (plus high waist circumference by the ATPIII, obesity and glucose domain by the WHO definition) remained associated with CHD.
Conclusions: In Iranian men and women, all three definitions of MetS were associated with CHD when considering the conventional risk factors. After further adjusting MetS components, none of these definitions showed association with CHD and only high blood pressure remained related to CHD in both sexes in all definitions.
Key words
coronary heart disease - metabolic syndrome - men - women
References
- 1 Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998; 15 539-553
- 2 ▪ ▪. 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. 2001; 285 2486-2497
- 3 Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group . The metabolic syndrome – a new worldwide definition. Lancet. 2005; 366 1059-1062
- 4 Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001; 24 683-689
- 5 Keil U. The Worldwide WHO MONICA Project: results and perspectives. Gesundheitswesen. 2005; 67 38-45
- 6 MacNeill AM, Rosamond WD, Girman CJ, Golden SH, Schmidt MI, East HE, Ballantyne CM, Heiss G. The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care. 2005; 28 385-390
- 7 He Y, Jiang B, Wang J, Feng K, Chang Q, Fan L, Li X, Hu FB. Prevalence of the metabolic syndrome and its relation to cardiovascular dis-ease in an elderly Chinese population. J Am Coll Cardiol. 2006; 47 1588-1594
- 8 Tillin T, Forouhi N, Johnston DG, MacKeigue PM, Chaturvedi N, Godsland IF. Metabolic syndrome and coronary heart disease in South Asians, African-Caribbeans and white Europeans: a UK population-based cross-sectional study. Diabetologia. 2005; 48 649-656
- 9 Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Bonadonna RC, Muggeo M. Bruneck study . Carotid atherosclerosis and coronary heart disease in the metabolic syndrome: prospective data from the Bruneck study. Diabetes Care. 2003; 26 1251-1257
- 10 Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation. 2003; 107 391-397
- 11 Resnick HE, Jones K, Ruotolo G, Jain AK, Henderson J, Lu W, Howard BV. Strong Heart Study . Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease in nondiabetic American Indians: the Strong Heart Study. Diabetes Care. 2003; 26 861-867
- 12 Kelishadi R, Ardalan G, Gheiratmand R, Majdzadeh R, Hosseini M, Gouya MM, Razaghi EM, Delavari A, Motaghian M, Barekati H, Mahmoud-Arabi MS, Lock K. Caspian Study Group . Thinness, overweight and obesity in a national sample of Iranian children and adolescents: CASPIAN Study. Child Care Health Dev. 2008; 34 44-54
- 13 Rashidi A, Mohammadpour-Ahranjani B, Vafa MR, Karandish M. Prevalence of obesity in Iran. Obes Rev. 2005; 6 ((3)) 191-192
- 14 Zabetian A, Hadaegh F, Azizi F. Prevalence of metabolic syndrome in Iranian adult population, concordance between the IDF with the ATPIII and the WHO definitions. Diabetes Res Clin Pract. 2007; 77 251-257
- 15 Hadaegh F, Harati H, Ghanbarian A, Azizi F. Prevalence of coronary heart disease among Tehranian adults: Tehran Lipid and Glucose Study, Eastern Mediterranean Health Journal. , [In press]
- 16 Azizi F, Rahmani M, Emami H, Madjid M. Tehran Lipid and Glucose Study: rationale and design. CVD prevention. 2000; 3 242-247
-
17 Prineas RJ, Crow RS, Blackburn H.
The Minnesota code manual of electrocardiographic findings: standards and procedures for measurements and classification . Boston: John Wright PCG Inc 1982 - 18 Ford ES, Giles WH, Croft JB. Prevalence of nonfatal coronary heart disease among American adults. Am Heart J. 2000; 139 371-377
- 19 Azizi F, Rahmani M, Emami H, Mirmiran P, Hajipour R, Madjid M, Ghanbili J, Ghanbarian A, Mehrabi Y, Saadat N, Salehi P, Mortazavi N, Heydarian P, Sarbazi N, Allahverdian S, Saadati N, Ainy E, Moeini S. Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1). Soz Praventivmed. 2002; 47 408-426
- 20 Friedwald WT, Levy RI, Fredridson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972; 18 499-502
- 21 Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA. Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol. 2002; 156 1070-1077
- 22 Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med. 1999; 16 442-443
-
23 Ahmad O, Boschi-Pinto C, Lopez A, Murray CJL, Lozano R, Inoue M.
Age Standardization of Rates: a New WHO Standard (GPE Discussion Paper Series No. 31) . Geneva: World Health Organization 2000 - 24 Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP. San Antonio Heart Study . National Cholesterol Education Program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study. Circulation. 2004; 110 1251-1257
- 25 Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care. 2005; 28 1769-1778
- 26 Rutter MK, Meigs JB, Sullivan LM, D'Agostino Sr RB, Wilson PW. C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study. Circulation. 2004; 110 380-385
- 27 Malik S, Wong ND, Franklin SS, Kamath TV, L'Italien GJ, Pio JR, Williams GR. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004; 110 1245-1250
- 28 Ford ES. The metabolic syndrome and mortality from cardiovascular disease and all-causes: findings from the National Health and Nutrition Examination Survey II Mortality Study. Atherosclerosis. 2004; 173 309-314
- 29 Bataille V, Perret B, Dallongeville J, Arveiler D, Yarnell J, Ducimetiere P, Ferrieres J. Metabolic syndrome and coronary heart disease risk in a population-based study of middle-aged men from France and Northern Ireland. A nested case-control study from the PRIME cohort. Diabetes Metab. 2006; 32 475-479
- 30 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. 2002; 288 2709-2716
- 31 Dekker JM, Girman C, Rhodes T, Nijpels G, Stehouwer CD, Bouter LM, Heine RJ. Metabolic syndrome and 10-year cardiovascular disease risk in the Hoorn Study. Circulation. 2005; 112 666-673
- 32 Grundy SM, Brewer Jr HB, Cleeman JI, Smith Jr SC, Lenfant C. American Heart Association; National Heart, Lung, and Blood Institute . Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004; 109 433-438
- 33 Alexander CM, Landsman PB, Teutsch SM, Haffner SM. Third National Health and Nutrition Examination Survey (NHANES III); National Cholesterol Education Program (NCEP) . NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes. 2003; 52 1210-1214
- 34 Scuteri A, Najjar SS, Morrell CH, Lakatta EG. Cardiovascular Health Study . The metabolic syndrome in older individuals: prevalence and prediction of cardiovascular events: the Cardiovascular Health Study. Diabetes Care. 2005; 28 882-887
- 35 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. 2003; 108 414-419
- 36 Festa A, D’Agostino Jr R, Howard G, Mykkänen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation. 2000; 102 42-47
- 37 Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993; 16 434-444
- 38 Inchiostro S, Fadini GP, Kreutzenberg SV de, Citroni N, Avogaro A. Is the metabolic syndrome a cardiovascular risk factor beyond its specific components?. J Am Coll Cardiol. 2007; 49 ((25)) 2465 , ; author reply 2465–2466. Epub 2007 Jun 11. ??
- 39 Lawlor DA, Smith GD, Ebrahim S. Does the new International Diabetes Federation definition of the metabolic syndrome predict CHD any more strongly than older definitions? Findings from the British Women's Heart and Health Study. Diabetologia. 2006; 49 41-48
- 40 Mühlen D Von, Langer RD, Barrett-Connor E. Sex and time differences in the associations of non-high-density lipoprotein cholesterol versus other lipid and lipoprotein factors in the prediction of cardiovascular death (The Rancho Bernardo Study). Am J Cardiol. 2003; 91 1311-1315
- 41 Ford ES, Giles WH, Croft JB. Prevalence of nonfatal coronary heart disease among American adults. Am Heart J. 2000; 139 371-377
- 42 Klein BE, Klein R, Lee KE. Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in Beaver Dam. Diabetes Care. 2002; 25 ((10)) 1790-1794
- 43 Hadaegh F, Zabetian A, Harati H, Azizi F. The prospective association of general and central obesity variables with incident type 2 diabetes in adults, Tehran lipid and glucose study. Diabetes Res Clin Pract. 2007; 76 449-454
- 44 Rashidi A, Mohammadpour-Ahranjani B, Vafa MR, Karandish M. Prevalence of obesity in Iran. Obes Rev. 2005; 6 191-192
Correspondence
F. Hadaegh
Endocrine Research Center
Shahid Beheshti University (M. C)
PO Box 19395-4763
Tehran
I. R. Iran
Phone: +98/21/2240 93 09
Fax: +98/21/2240 24 63
Email: fzhadaegh@erc.ac.ir