The importance of diagnostic criteria in the association between the metabolic syndrome and cardiovascular disease in obese subjects.

OBJECTIVE:To investigate whether the association between the metabolic syndrome (MS) and cardiovascular disease (CVD) in obese adults is influenced by the criteria used to diagnose the MS.DESIGN AND SUBJECTS:Cross-sectional study in 389 obese adults (male/female: 26%/74%; body mass index (BMI): 30.1-63.2?kg/m²; age: 18-79?y).MEASUREMENTS:To diagnose the MS by the WHO or the ATPIII criteria, body mass index, waist circumference, fasting and 2-h oral Glucose tolerance test plasma glucose, fasting plasma triglycerides and HDL cholesterol, systolic and diastolic blood pressure, 24-h albumin excretion, and fasting insulin were measured. The association between the MS diagnosed with either definition and self-referred CVD was investigated.RESULTS:The prevalence of the MS by the WHO was higher than by the ATPIII criteria (WHO 69.1%, ATPIII 49.4%; P<0.001). The MS diagnosed by the WHO criteria was significantly associated with self-referred CVD (odds ratio (OR) 5.80, 95%CI 1.35-24.95, P<0.05), whereas the ATPIIII MS was not (OR 1.34, 95%CI 0.59-3.03). An elevated blood pressure (OR 5.04, 95%CI 1.41-18.01, P<0.05) and microalbuminuria (OR 2.61, 95%CI 1.06-6.40, P<0.05) were independently associated with CVD. Consideration of the OGTT data as part of the ATPIII MS definition improved its associations with CVD (OR 4.39, 95%CI 1.29-14.94, P<0.05).CONCLUSION:The WHO criteria appear to identify a greater number of obese adults at risk for CVD. Nevertheless, the addition of an OGTT at least in nondiabetic patients with two ATPIII-defined metabolic risk factors may help to improve the association between the MS and CVD in obese adults.International Journal of Obesity (2005) 29, 668-674. doi:10.1038/sj.ijo.0802921 Published online 8 March 2005 [ABSTRACT FROM AUTHOR]