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Abstract
Objective Metabolic syndrome (MetS) is a notable risk factor of coronary heart disease (CHD). However, there are differences in the methods used to define MetS. The purpose of this study was to determine which MetS definition most fully reflects the 10-year probability of CHD based on the Framingham risk algorithm.
Design Cross-sectional study.
Setting Data were obtained from the China Health and Nutrition Survey and the Influencing Factors of Chronic Diseases Survey conducted among residents of Nanshan District in Shenzhen, China.
Participants In total, 1721 participants aged 20–80 years were included in this study.
Methods MetS was diagnosed according to the criteria of the National Cholesterol Education Program’s Adult Treatment Panel (revised NCEP-ATP III), the International Diabetes Federation (IDF) and the Chinese Diabetes Society (CDS). The NCEP-ATP III algorithm was used to calculate the Framingham risk score, and the Framingham risk score was used to define the probability of developing CHD within 10 years either as low (<6%), moderate (6%–10%), moderately high (10%–20%) or high (>20%). Chi-square tests with or without the Bonferroni correction were used to compare the differences in the distribution of the 10-year estimated risk of developing CHD among the three definitions.
Results Compared with the other definitions, the revised NCEP-ATP III criteria identified more participants (30.96%, 95% CI 28.8% to 33.2%) as having MetS, while the CDS criteria showed the highest 10-year probability of developing CHD. The 10-year probability of developing CHD in the participants with MetS was significantly higher than that in the participants without MetS (CDS: χ2=157.65, revised ATP III: χ2=45.17, IDF: χ2=306.15, all p<0.001), and all definitions more fully reflect the CHD risk in men than in women (revised NCEP-ATP III: χ2=72.83; IDF: χ2=63.60; CDS: χ2=23.84; all p<0.001).
Conclusions This study demonstrates the differences in the prevalence and distribution of the 10-year estimated risk of developing CHD based on the definition of MetS. A significant finding of this study is that the MetS definitions have better performance for men than for women. Further studies in China, especially longitudinal studies, are needed to determine which definition of MetS is best suited for predicting CHD risk.
- metabolic syndrome
- comparison
- coronary heart disease risk assessments
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Footnotes
XP and LH contributed equally.
Contributors The author contributions were as follows: XP and LH conceived and designed the study and critically revised the manuscript; JZ analysed the data and wrote the paper; QG and JW participated in the laboratory assay; and MZ, JM, CW and HC collected the data and revised the manuscript. All authors read and approved the final version of the manuscript.
Funding The present study was jointly supported by the National Natural Science Foundation of China (no. 81573149), Projects Funded of Health and Family Commission of Shenzhen Municipality (no. 201502017 and no. SZSJ2017001) and Project Funded of Nanshan District, Shenzhen Science and Technology Innovation Bureau (no. 2015064).
Competing interests None declared.
Patient consent Obtained.
Ethics approval The study was approved by the Ethics Committee of the Shenzhen Nanshan Center for Chronic Disease Control.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.