The metabolic syndrome and cardiovascular disease

Figures & data

Table I. Diagnostic criteria of the metabolic syndrome according to WHO 6.

Impaired glucose regulation (impaired fasting glucose, IFG; impaired glucose tolerance, IGT; type 2 diabetes mellitus) and/or

insulin resistance (under hyperinsulinaemic euglycaemic conditions, glucose uptake below lowest quartile for background population under investigation), with

two or more of the components listed below:

• impaired glucose regulation

• insulin resistance

• hypertension (systolic ⩾140 mmHg and/or diastolic ⩾90 mmHg and/or anti‐hypertensive treatment)

• dyslipidaemia (triglycerides ⩾1.7 mmol/L and/or HDL cholesterol <0.9 mmol/L in men and <1.0 mmol/L in women)

• central obesity (WHR >0.90 in men and >0.85 in women and/or BMI >30)

• microalbuminuria (urinary albumin excretion >20 µg/min or urinary albumin/creatinine ratio >30 mg/g)

Table II. Diagnostic criteria of the metabolic syndrome according to NCEP‐ATP III 7.

Any combination of three or more of the following clinical/biochemical abnormalities:

• fasting plasma glucose ⩾6.1 mmol/L or known diabetes

• systolic blood pressure ⩾130 and/or diastolic blood pressure ⩾85 mmHg and/or treatment

• plasma triglycerides ⩾1.7 mmol/L

• plasma HDL‐cholesterol <1.03 mmol/L in men and <1.29 mmol/L in women

• waist circumference >102 cm in men or >88 cm in women.

Table III. Diagnostic criteria of the metabolic syndrome according to IDF 8.

Central obesity (waist ⩾94 cm in Europid men and ⩾80 cm in Europid women; cut‐offs are different for other ethnic groups), plus

any two of the following four abnormalities:

• raised triglycerides (⩾1.7 mmol/L) or specific treatment for this abnormality

• reduced HDL cholesterol (<1.03 mmol/L in men; <1.29 mmol/L in women) or specific treatment for this abnormality

• raised blood pressure (systolic ⩾130 and/or diastolic ⩾85 mmHg) or treatment for previously diagnosed hypertension

• raised fasting plasma glucose (⩾5.6 mmol/L) or previously diagnosed type 2 diabetes

Table IV. Ancillary (not diagnostic) features of the metabolic syndrome. These features are often but not necessarily found in subjects with the metabolic syndrome. The list is incomplete.

Raised levels	Reduced levels
PAI‐1
Fibrinogen
Factor VII, factor VIII
vonWillebrand factor
Apoprotein B	Apoprotein A‐1
Small dense LDL
Oxidized LDL
Free fatty acids
Urate
Leukocytes
CRP
ESR
Ferritin
Sialic acid
α‐1 Acid Glycoprotein
Amyloid A
TNF‐α
IL‐6
Homocystein
E‐selectin
P‐selectin
ICAM‐1
VCAM‐1
Leptin	Adiponectin
Resistin
Asymmetric dimethylarginine
GOT (AST)‐ GPT (ALT)
Gamma‐GT

Table V. Risk of CHD morbidity or mortality in subjects with the metabolic syndrome.

First author: (Study)	Country	No. of subjects	Years of follow‐up	WHO criteria OR/HR/RR	NCEP criteria OR/HR/RR
Bonora: (Bruneck study)	Italy	888	5	2.03 (1.2–4.3)	1.50 (NS)
Isooma: (Botnia study)	Finland	3606	7	1.81 (1.24–2.65)
Lakka: (Kuopio study)	Finland	1209	11	Men 2.87 (1.22–6.78)	Men 4.16 (1.60–10.8)
Sattar: (WOSCOPS)	Scotland	6447	5		Men 1.30 (1.00–1.67)
Hu: (DECODE)	Europe	11,512	9	Men 2.26 (1.61–3.17)
				Women 2.78 (1.57–4.94)
McNeill: (ARIC)	USA	12,089	11		Men 1.46 (1.23–1.74)
					Women 2.05 (1.59–2.64)
Hunt: (SAHS)	USA	2815	13	Men 1.15 (NS)	Men 1.82 (1.14–2.91)
				Women 2.83 (1.55–5.17)	Women 4.65 (2.35–9.21)
Malik: (NHANES)	USA	6255	13		2.02 (1.42–2.89)

OR = odds ratio; HR = hazard ratio; RR = relative risk. 95% C.I. are given in parentheses. See text for more details about the studies.

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