ORIGINAL ARTICLE J Nepal Med Assoc 2011;51(184):157-63 Association of Cardiovascular Risk Factors in Hypertensive Subjects with Metabolic Syndrome De ned by Three Different De nitions Shrestha R 1, Jha SC 2, Khanal M 3, Gyawali P 3, Yadav BK 3, Jha B 3 1 Department of Biochemistry, Nepal Medical College, Kathmandu, Nepal 2 Department of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. 3 Department of Biochemistry, Tribhuvan University Teaching Hospital, Kathmandu, Nepal ABSTRACT Introduction: Different authorities have put forward their criteria to define metabolic syndrome (MetS). The aim of this study was to find the prevalence of MetS in hypertensive individuals by the available three different definitions from National Cholesterol Education Program (NCEP), International diabetes Federation () and and their association with other cardiac risk factors. Methods: After anthropometric measurements fasting blood was analyzed for glucose, lipids, high sensitivity C-reactive protein (hscrp) and anti-oxidized LDL antibody in 150 hypertensive individuals. A ten-year coronary heart disease risk was predicted using the Framingham risk score (FRS). Results: The prevalence of MetS was 54.7 % by NCEP, 42.0 % by ) and 18.7 % by. As many as 63.4 % had MetS by any definition, while only 9.4 % fulfilled all the criteria of the three definitions. The association of cardiac risk factors also varied according to the definition used. hscrp was significantly elevated in MetS compared to non-mets. Body mass index, waist circumference and HDL-C were associated in MetS defined by NCEP and. FRS was higher in MetS defined by Adult Treatment Panel and definitions. An increase in urine albumin and a decrease in egfr were associated with MetS individuals defined by only. Conclusion: There is a wide variation in the prevalence of MetS and associated cardiac risk factors according to three different definitions used. The different cardiac risk factors among MetS also vary with the definitions used. However, hscrp and emerging risk factor are significantly elevated in hypertensive individuals with MetS as defined by all definitions Keywords: Cardiovascular risk factors, hypertension, metabolic syndrome INTRODUCTION Correspondence: Mr. Rojeet Shrestha, Department of Biochemistry, Nepal Medical College, Atterkhel, Jorpati, Kathmandu, PO Box 13344, E-mail:- cl.bichem@gmail.com, Mob no: 9841385536 157
METHODS RESULTS 158
Table 1. Prevalence of the components of metabolic syndrome by three definitions (NCEP-ATPIII, and ) NCEP ATP III Figure 1 MetS 35 (49.3) 47 (59.5) 82 (54.7) 2 5 NCEP 2 4 1 5 NCEP 16 10 3 10 NCEP 18 14 1 23 0 16 1 39 5 71 MALE 5 79 FMALE 10 150 TOTAL Figure 2 MetS 12 (16.9) 16 (20.3) 28 (18.7) MetS 32 (45.0) 31 (39.2) 63 (42.0) 159
Table 2. Baseline characteristics in relation to the presence of the metabolic syndrome, by three definitions (NCEP- ATPIII, and ) 160
Table 3. Proportion of individuals with MetS (NCEP-ATPIII, or ) fulfilling each criteria of the syndrome NECP ATPIII MetS (n) MetS criteria: Total HTN Subjects (N) 150 150 150 Table 4. Association of the grade of risk according to hscrp and FRS among Mets by the three definitions NCEP ATP III 161
DISCUSSION 162
CONCLUSIONS REFERENCES 1. Grundy SM, Hansen B, Smith SC Jr, Cleeman JI, Kahn RA; American Heart Association; National Heart, Lung, and Blood Institute; American Diabetes Association.Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/ American Diabetes Association conference on scientific issues related to management. Circulation. 2004;109:551-6. 2. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288:2709-16. 3. Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24:683-9. 4. Ramaraj R, Chellappa P. Cardiovascular risk in South Asians. Postgrad Med J. 2008;84:518-23. 5. Cockcroft D, Gault MK. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31-41. 6. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499-502. 7. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26:3160-7. 8. Wilson PW, D Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837-47. 9. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-97. 10. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C. American Heart Association; National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004;109:433-8. 11. Alberti KG, Zimmet P, Shaw J; Epidemiology Task Force Consensus Group. The metabolic syndrome-a new worldwide definition. Lancet. 2005;366:1059-62. 12. Alberti KG, Zimmet PZ, Consultation. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a Consultation. Diabet Med. 1998;15:539-53. 13. Ninomiya JK, L Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS. Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation. 2004;109:42-46. 14. Basit A, Shera AS. Prevalence of Metabolic Syndrome in Pakistan. Metab Syndr Relat Disord. 2008;6:171-5. 15. Lee CM, Huxley RR, Woodward M, Zimmet P, Shaw J, Cho NH, et al. Comparisons of metabolic syndrome definitions in four populations of the Asia-Pacific region. Metab Syndr Relat Disord. 2008;6:37-46. 16. Desroches S, Lamarche B. The evolving definitions and increasing prevalence of the metabolic syndrome. Appl Physiol Nutr Metab. 2007;32:23-32. 17. Kolovou GD, Anagnostopoulou KK, Salpea KD, Mikhailidis DP. The prevalence of metabolic syndrome in various populations. Am J Med Sci. 2007,333:362-71. 18. Procopiou M, Philippe J. The metabolic syndrome and type 2 diabetes: epidemiological figures and country specificities. Cerebrovasc Dis. 2005;20(Suppl 1):2-8. 19. Ruderman, N, Chisholm D, Pi-Sunyer X, Schneider S. The metabolically obese, normal-weight individual revisited. Diabetes. 1998;47:699-713. 20. Dodson PM, Shine B. Retinal vein occlusion: C-reactive protein and arterial hypertension. Acta Ophthalmol (Copenh). 1984;62:123-130. 21. Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB. Production of C-reactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet. 1997;349:462-6. 22. Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282:2131-5. 23. Aronson D, Bartha P, Zinder O, Kerner A, Markiewicz W, Avizohar O, et al. Obesity is the major determinant of elevated C-reactive protein in subjects with the metabolic syndrome. Int J Obes Relat Metab Disord. 2004;28:674-9. 24. Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation. 2003;107:391-7. 25. Schillac G, Pirro M, Vaudo G, Gemelli F, Marchesi S, Porcellati, et al. Prognostic value of the metabolic syndrome in essential hypertension. J Am Coll Cardiol. 2004;43;1817-22. 163