Metabolic Syndrome With and Without C-Reactive Protein as a Predictor of Coronary Heart Disease and Diabetes in the West of Scotland Coronary Prevention Study

TLDR

The National Cholesterol Education Program recently proposed a simple definition for metabolic syndrome. The study aimed to evaluate the prospective association of a modified NCEP metabolic syndrome definition, using BMI instead of waist circumference, with coronary heart disease and type 2 diabetes risk. Baseline data from 6,447 men in the West of Scotland Coronary Prevention Study were used to assess CHD risk and 5,974 men for incident diabetes over 4.9 years, with C‑reactive protein levels higher among those with metabolic syndrome. Metabolic syndrome markedly increased risk of coronary heart disease and type 2 diabetes, with multivariate CHD hazard ratio 1.30 and diabetes hazard ratio 3.50, and C‑reactive protein further improved prognostication; individuals with 4–5 syndrome features had 3.7‑fold higher CHD risk and 24.5‑fold higher diabetes risk, while pravastatin reduced CHD risk similarly in those with and without the syndrome.

Abstract

The National Cholesterol Education Program (NCEP) recently proposed a simple definition for metabolic syndrome. Information on the prospective association of this definition for coronary heart disease (CHD) and type 2 diabetes is currently limited.We used a modified NCEP definition with body mass index in place of waist circumference. Baseline assessments in the West of Scotland Coronary Prevention Study were available for 6447 men to predict CHD risk and for 5974 men to predict incident diabetes over 4.9 years of follow-up. Mean LDL cholesterol was similar but C-reactive protein was higher (P<0.0001) in the 26% of men with the syndrome compared with those without. Metabolic syndrome increased the risk for a CHD event [univariate hazard ratio (HR)=1.76 (95% CI, 1.44 to 2.15)] and for diabetes [univariate HR=3.50 (95% CI 2.51 to 4.90)]. Metabolic syndrome continued to predict CHD events (HR=1.30, 95% CI, 1.00 to 1.67, P=0.045) in a multivariate model incorporating conventional risk factors. Men with 4 or 5 features of the syndrome had a 3.7-fold increase in risk for CHD and a 24.5-fold increase for diabetes compared with men with none (both P<0.0001). C-reactive protein enhanced prognostic information for both outcomes. With pravastatin, men with the syndrome had similar risk reduction for CHD as compared with those without (HR, 0.73 and 0.69; pravastatin versus placebo).A modified NCEP metabolic syndrome definition predicts CHD events, and, more strikingly, new-onset diabetes, and thus helps identify individuals who may receive particular benefit from lifestyle measures to prevent these diseases.