| Metabolic syndrome is a cluster of risk factors for cardiovascular disease, including obesity, diabetes or impaired fasting glucose, dyslipidemia, and hypertension. The aggregation of these risk factors in individual increased the prevalence rates of diabetes mellitus and cardiovascular diseases. The phenomenon of multiple metabolic disorders aggregation has been recognized a long time and the nature and pathogenesis have been revealed. Since Reavan proposed the concept of "X syndrome", this syndrome also has gone through the names of "death Quartet", "common soil hypothesis," "insulin resistance syndrome" and so on. After WHO proposed the first working criteria of MS in 1999, different countries and organizations proposed several other MS diagnostic criteria, while further studies need to be carried out for the applicability of those MS criteria in different population.ObjectiveTo compare the prevalence rates, sensitivity, specificity and consistency under different criteria for MS proposed by CDS (2004), IDF (2005), and NCEP-ATPⅢ(2005) in a large population, to look for the suitable MS criterion for Chinese population, and to provide scientific evidence for better carrying out the primary and secondary prevention for cardiovascular diseases.MethodsA total of 20152 participants aged 18 years old and over in Xin'an county of Henan were selected randomly by cluster sampling technique from July to August in 2007 and 2008. Data were collected by questionnaire interview which include demographic characteristics (sex, age, marital status, educational level, and per capita annual income), behaviour risk factors (smoking, alcohol drinking and diet), information regarding family history, and history of illness and physical activities. Anthropometric measurements included height, weight, waist circumferences (WC), blood pressure, fasting plasma glucose (FPG), total cholesterol (TC), triglyeride (TG), and high density lipoprotein cholesterol (HDL-C) were measured. Cross-sectional study was used to calculate the prevalence rates of MS under the criteria proposed by CDS (2004), IDF (2005), and NCEP-ATPIII (2005) for this population. Each of the three diagnostic criteria was considered as "gold standard" and the other two were compared for the accuracy measurements.Results1. Totally 20152 individuals were investigated. The males were 7911 (39.26%), and the females were 12241 (60.74%); the average age was (50.67±13.67) years old.2. The prevalence rate of abdominal obesity and obesity were 44.12% and 39.05%, respectively. Hyperglycemia was 34.08% by the IDF/ATPⅢcriterion,15.51% by the CDS criterion. High levels of blood pressure (BP>130/85 mmHg) was 39.28%, hypertension (BP≥140/90 mmHg) was 24.81%. Hypertriglyceridemia was 33.96%, Low HDL-C was 56.60% by IDF/ATPⅢcriterion, which down to 20.87% when the CDS criterion was used.3. The crude prevalence rate of MS was 16.73%,31.72%,38.42% by CDS, IDF and ATPIII, respectively. The standardized prevalence was 11.36%,24.16%,29.20%, respectively. The prevalence of male, female and the total participant shows that ATPIII had the highest prevalence and CDS had the lowest. The prevalence rate of MS diagnosed by at least one criterion was 38.84%,14.68% by all the three criteria diagnosed.4.97.48% of the MS diagnosed by the CDS criterion had three or more risk factors aggregation,26.55% of the non-MS diagnosed by the CDS criterion had three or more risk factors aggregation.100% of the MS diagnosed by the IDF criterion had three or more risk factors aggregation,9.81% of the non-MS diagnosed by the IDF criterion had three or more risk factors aggregation.100% of the MS diagnosed by the ATPⅢcriterion had three or more risk factors aggregation.5. The most common combination of MS diagnosed by the CDS criterion was obesity, hypertension, and dyslipidemia; the most common combination of MS diagnosed by the IDF criterion was abdominal obesity, high levels of blood presure, and low HDL-C; the most common combination of MS diagnosed by the ATPIIIcriterion was abdominal obesity, high levels of blood presure, and low HDL-C. 6. The Kappa statistic between ATPⅢand IDF was 0.85, which shows high level of consistency. The Kappa statistic between ATPⅢand CDS, CDS and IDF was 0.47 and 0.50, respectively, which shows the moderate consistency. The area under the ROC curve of ATPⅢand CDS was 0.951 and 0.716, respectively, when the IDF criterion served as the reference criterion, and the area under the ROC curve of IDF and CDS was 0.913 and 0.709 respectively, while the ATPⅢcriterion served as the reference criterion.7. When the ATPⅢcriterion served as "gold standard", the number of false negative of MS patients by CDS was 4456, of which 43.90% had three risk factors aggregation; the number of false negative by IDF was 1350, of which 42.74% had three risk factors aggregation. When the IDF criterion served as "gold standard", the number of false negative by CDS was 3434, of which 44.90% had three risk factors aggregation. When the CDS criterion served as "gold standard", the number of false negative by ATPⅢwas 85, of which 1.18% had three risk factors aggregation; the number false negative by IDF was 413, of which 39.71% had three risk factors aggregation.8. The sensitivity and specificity of IDF and CDS were 0.83 and 1.00,0.42 and 0.99, respectively, when the ATPⅢcriterion was taken as the "gold standard", and the sensitivity and specificity of IDF and CDS in parallel were 0.87 and 0.99, respectively, when the ATPⅢcriterion was taken as the "gold standard".Conclusions1. The ATP III criterion yields the highest prevalence of MS, but the CDS yields the lowest. The ATP III and IDF criteria have a better agreement in determining the prevalence of MS in Chinese population.2. The most common combination of MS in Henan rural areas is obesity, hypertension, and dyslipidemia.3. The current diagnostic criteria used in parallel mode can increase the sensitivity for MS screening in the population.
|
PDF Full Text Request