A Cohort Study On The Interactions Among Metabolic Syndrome Components To Predict The Risk Of CVD Among Kazakhs

Objective1.This study aimed to determine whether the risk of cardiovascular diseases(CVD)caused by metabolic syndrome(MS)is greater than the sum of their components when multiple metabolic abnormalities coexist simultaneously,or whether MS predicts CVD independent of MS components.2.To compare MS with the Framingham risk score(FRS)as predictors of CVD among Kazakhs in Xinjiang.Moreover,an applicable tool for predicting the risk of developing CVD was identified.Methods1.In this prospective study,participants(total 2,644)were recruited from the cohort study of metabolic syndrome and its various factors on risk prediction for cardiovascular disease in Kazakh,Xinjiang,who had been followed up for five years.Two follow-up surveys were conducted in the form of face-to-face interviews in April 2013,April 2016,and April 2017,respectively.We observed the incidence of CVD during the follow-up period.only 2,286 out of 2,644 participants were followed-up with a follow-up rate of 86.46%.Te median follow-up period was 5.49 person-years(in total 11,014.92 person-years).A total of 281 individuals who developed CVD at baseline survey were excluded from the analysis.Overall,only 2,005 individuals were included in the cohort analysis.2.Data were analyzed using SPSS version 17.0.Mainly using t-test,one-way ANOVA,Chi-square test,and a cox regression model was used to evaluate the association between each MS component with the development of CVD.3.The multiplicative interactions among MS components were evaluated by incorporation of the dummy variable into a cox regression model.The additive interactions among MS components were evaluated by calculating the additive interaction index.4.A cox regression model was used to establish a CVD risk prediction model based on the interactions among MS components and divide the CVD hazard level.5.Referring to the FRS,we assigned a value to each component of MS to establish the MS scoring system.MS risk score and FRS were compared in terms of their ability in predicting development of CVD using cox regression and receiver operating characteristic curve.Results1.A total of 303 participants developed CVD during the follow-up period,and the incidence of CVD was 15.11%.2.The risk of CVD increased significantly with increasing number of MS components,and this trend persisted even after adjusting for sex,drinking status,and family history of hypertension,diabetes,and CVD.3.A univariate analysis showed that MS and its components were associated with CVD.After the adjustment for the traditional risk factors,CVD,MS and its components were still significantly associated with CVD.After the mutual adjustment for each MS component and the above traditional risk factors,blood pressure(BP)is most strongly associated with CVD,whereas fasting plasma glucose(FPG)were not associated with CVD.4.The interaction analysis of BP and waist circumference(WC),BP and triglyceride(TG),WC and TG,BP and high density lipoprotein cholesterol(HDL-C),WC and HDL-C found that the coexistence of these factors will increase the risk of CVD.However,the above four indicators did not find additive interactions.5.After the CVD hazards were divided into four levels,it was showed that found that 0~4.96% of the incidence probability was in the low-risk population,4.96~22.08% in the general-risk population,22.08~46.52% in the moderate-risk population,and 46.52~100.00% in the high-risk population.6.In addition,each component of MS was appraised individually and was analyzed using the ROC curve.We found that BP had the best predictive ability.7.The study found that TC,smoking history,WC,TG,and FPG may not be the main factors that influence MS risk score and FRS's prediction of CVD.8.The study found that the predictive ability of MS risk score including age was superior to FRS.MS risk score including age may be a better predictor of CVD and may more accurately reflect the CVD of Kazakhs in Xinjiang.9.The association of CVD in participants in each quintile of the MS risk score including age were higher than the corresponding FRS group on the same exposed condition.Conclusions1.The incidence of CVD in Kazakhs was 15.11%,which was higher than the national average in China.2.The risk of CVD increased significantly with increasing number of MS components,exhibiting a significant and dose–response trend.3.BP,WC,TG,and HDL-C were independent risk factors for CVD development in the Kazakh populations.The multiplicative interactions between the above four components could increase the risk of CVD.4.The risk of CVD in Kazakh population is divided into four levels: low,general,moderate and high-risk population.The classification of CVD hazard level provides an easy assessment tool forhealth education and health promotion in the Kazakh population.5.The predictive ability of MS risk score including age was superior to FRS.MS risk score including age may be a better Predictor of CVD among Kazakhs.