The Metabolic Syndrome Defined By Factor Analysis And The Principal Factors With Incident Metabolic Syndrome, Cardiovascular Disease And Type 2 Diabetes Mellitus

ObjectiveWe applied factor analysis to investigate the clustering of hypertension, dyslipidemia, glucose intolerance, inflammation, obesity, particularly central obesity ,and how the major components of the metabolic syndrome relate to each other in Jiangsu Province of China. To examine how the major principal factors of the metabolic syndrome relate to each other and to the development of metabolic syndrome, cardiovascular disease, type 2 diabetes. Also to compare the factors with the global metabolic syndrome as which one have the better predictive value of cardiovascular disease and type 2 diabetes.Methods1.Using the baseline survey data of the project of Multiple Metabolic Disorders and Metabolic Syndrome,a study which was conducted including 5888 cases, factor analysis was performed using the principle components analysis with varimax orthogonal rotation of continuously distributed variables considered to represent the components of the metabolic syndrome.2. According to the factor loading matrix table, we using the formula Y=aX1 +bX2 + cX3 + dX4 + eX5 + fX6 + gX7 + hX8+iX9 to turn the 9 variables into 5 principal factors. Then we apply the metabolic syndrome factors in the cohort study of Multiple Metabolic Disorders and Metabolic Syndrome (n=1946), make every factor three equation to compare the metabolic syndrome, cardiovascular disease, type 2 diabetes incidence of each group.3. Factors identified at baseline were used as independent variables in univariate and multivariate Cox ratio hazard models to determine risk factor clusters predicting the development of metabolic syndrome, cardiovascular disease, type 2 diabetes.Then use global metabolic syndrome as an independent variable in predicting cardiovascular disease and type 2 diabetes, and compare Factors with the metabolic syndrome as which one is better in predicting cardiovascular disease, type 2 diabetes.Results1. Five factors were identified in baseline subjects. BMI, WC, TG, HDL-C were associated with one factor, called Factor 1. Systolic and diastolic blood pressures, BMI, WC were associated with the second factor, called Factor2. LDL-C, BMI, WC were associated with the third factor, called Factor 3. FPG was associated with the fourth factor, called Factor 4. CRP was associated with the fifth factor, called Factor 5.The five factors can explain the 79% of the total variance of metabolic syndrome. Also Factor1, Factor2, Factor 3 connect each other with the effect of BMI, WC.2. The metabolic syndrome incidence of each group increased with the group except Factor 3, Factor 1 was the most conspicuous factors. Whether in the univariate or multivariate Cox model, all the five factors except Factor 3 predicted the development of metabolic syndrome. The combination of BMI, WC, TG, HDL-C, called Factor 1 was the most important factor.3. The cardiovascular disease incidence of each group increased with the group except Factor 3, Factor 2 was the most conspicuous factors. Whether in the univariate or multivariate Cox model, all the five factors except Factor 3 predicted the development of cardiovascular disease. The combination of systolic and diastolic blood pressures, BMI, WC, called Factor 2 was the most important factor. As compare to the predictive value of global metabolic syndrome, Factor 2 still has better predictive value than metabolic syndrome itself.4.The type 2 diabetes incidence of each group increased with the group except Factor 3, Factor 4 was the most conspicuous factors. Whether in the univariate or multivariate Cox model, all the five factors except Factor 3 predicted the development of type 2 diabetes. FPG was associated with the fourth factor, called Factor 4, was the most important factor. As compare to the predictive value of global metabolic syndrome, Factor 4 still has better predictive value than metabolic syndrome itself.Conclusion1. Finding more than one factor contradicts the unity hypothesis. Insulin resistance or obesity alone does not underlie all features of the metabolic syndrome.2. The metabolic syndrome, along with many other syndromes and diseases, is multifactorial in origin. The pathogenesis of the metabolic syndrome can be separated into underlying causes and exacerbating factors. Obesity/fat tissue maybe the most important physiological processes associated with various components of the metabolic syndrome about metabolic syndrome risk.3. Though the metabolic syndrome raises the risk for cardiovascular disease, systolic and diastolic blood pressures were strong independent predictors of cardiovascular disease, and its predictive value was better than that of the metabolic syndrome. Until much-needed research is completed, clinicians should evaluate and treat all CVD risk factors especially the blood pressure factor without regard to whether a patient meets the criteria for diagnosis of the'metabolic syndrome'.4. Though the metabolic syndrome raises the risk for type 2 diabetes, fasting plasma glucose was strong independent predictor of type 2 diabetes, and its predictive value was better than that of the metabolic syndrome. Until much-needed research is completed, clinicians should evaluate and treat type 2 diabetes without regard to whether a patient meets the criteria for diagnosis of the'metabolic syndrome'. We should control fasting plasma glucose first, in order to prevent type 2 diabetes.