Clinical Investigation
Coronary Artery Disease
Ten-year risk of cardiovascular incidence related to diabetes, prediabetes, and the metabolic syndrome

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Background

The relative contributions of the metabolic syndrome (MetS) and dysglycemia on the risk of cardiovascular disease (CVD) have not been dissected. We aimed to compare MetS with dysglycemia in their association with the 10-year incidence risk of CVD.

Methods

A total of 30 378 subjects were recruited from 11 provinces in the CMCS and followed-up for new coronary heart disease (CHD) and stroke events (ischemic stroke and hemorrhagic stroke) for 10 years. Incidence rates and HRs were estimated by the presence or absence of MetS, impaired fasting glucose (IFG) and diabetes, and by the various traits of MetS.

Results

Among the subjects, 18.2% were defined as having MetS; 21.1% had IFG, and 6.8% had diabetes. Metabolic syndrome prevalence in IFG and diabetes was 38.1% and 48.7%, respectively, and the prevalence of IFG and diabetes in MetS was 44.1% and 18.3%, respectively. After adjusting for nonmetabolic risk factors, HRs of total CVD, CHD, and ischemic stroke in MetS were significant and higher than those in non-MetS, regardless of glycemic status. In the absence of MetS, the impact of dysglycemia was found only in IFG to CHD and diabetes to ischemic stroke. Hyperglycemia without any concomitant disorders was not associated with significantly higher risk of CVD.

Conclusions

The increased CVD risk in individuals with IFG or diabetes was largely driven by the coexistence of multiple metabolic disorders rather than hyperglycemia per se. Identification of clustering of metabolic abnormalities should be given more consideration in CVD prevention.

Section snippets

Subjects

The CMCS was a nationwide, multicenter, prospective cohort study on CVD. As previously reported,9, 10 a total of 30 378 subjects 35 to 64 years of age and free of CVD were included with the informed consent. Ninety percent of the participants (n = 27 249) were recruited from the baseline survey in 1992, carried out in 16 centers from 11 provinces of China. In addition, 3129 subjects from Beijing were added in 1996 to 1999. The response rate was 82.1% and 75.0% for the 2 surveys, respectively.

Results

This study revealed the interrelations of MetS and dysglycemia in the middle-aged Chinese population. Among the subjects, 18.2% were defined as having MetS, 21.1% had IFG, and 6.8% had diabetes (Figure 1). The prevalence of MetS in IFG and diabetes was 38.1% and 48.7%, 4.0 and 5.1 times of that in subjects with normal fasting glucose (NFG), respectively. Sixty-two percent of the subjects with MetS had IFG or diabetes, which was 3.1 times of that prevalent in non-MetS. After adjustment for age

Discussion

The MetS consists of a clustering of metabolic risk factors and is associated with increased risk for CVD. One of the features of MetS is impaired glucose regulation. Several reports further indicate that dysglycemia, regardless of its severity, is accompanied by increased risk for CVD.16, 17, 18 To date, the relative contributions of MetS and dysglycemia on CVD risk have not been dissected. For example, Alexander et al6 indicated that most of the risk for CHD associated with diabetes in the US

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    This research was supported by the China National Grant on Science and Technology (85-915-01-02), China fundings from Beijing Municipal Bureau of Science and Technology (953850700) (Beijing, China), and Beijing NOVA Program (2003B26) (Beijing, China).

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