Risk classification for metabolic syndrome and the incidence of cardiovascular disease in japan with low prevalence of obesity: A pooled analysis of 10 prospective cohort studies

Hiroyasu Iso, Renzhe Cui, Iseki Takamoto, Masahiko Kiyama, Isao Saito, Tomonori Okamura, Yoshihiro Miyamoto, Aya Higashiyama, Yutaka Kiyohara, Toshiharu Ninomiya, Michiko Yamada, Hideaki Nakagawa, Masaru Sakurai, Michio Shimabukuro, Moritake Higa, Kazuaki Shimamoto, Shigeyuki Saito, Makoto Daimon, Takamasa Kayama, Mitsuhiko NodaSadayoshi Ito, Koutaro Yokote, Chikako Ito, Kazuwa Nakao, Toshimasa Yamauchi, Takashi Kadowaki

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: It is uncertain whether risk classification under the nationwide program on screening and lifestyle modification for metabolic syndrome captures well high-risk individuals who could benefit from lifestyle interventions. We examined the validity of risk classification by linking the incidence of cardiovascular disease (CVD). CONCLUSIONS: Similar CVD excess and attributable risks among individuals with metabolic syndrome components in the absence and presence of obesity/overweight imply the need for lifestyle modification in both high-risk groups. METHODS AND RESULTS: Individual-level data of 29 288 Japanese individuals aged 40 to 74 years without a history of CVD from 10 prospective cohort studies were used. Metabolic syndrome was defined as the presence of high abdominal obesity and/ or overweight plus risk factors such as high blood pressure, high triglyceride or low high-density lipoprotein cholesterol levels, and high blood glucose levels. The risk categories for lifestyle intervention were information supply only, motivation-support intervention, and intensive support intervention. Sex-and age-specific hazard ratios and population attributable fractions of CVD, which were also further adjusted to consider non– high density lipoprotein cholesterol levels, were estimated with reference to nonobese/overweight individuals, using Cox proportional hazard regression. Since the reference category included those with risk factors, we set a supernormal group (nonobese/overweight with no risk factor) as another reference. We documented 1023 incident CVD cases (565 men and 458 women). The adjusted CVD risk was 60% to 70% higher in men and women aged 40 to 64 years receiving an intensive support intervention, and 30% higher in women aged 65 to 74 years receiving a motivation-support intervention, compared with nonobese/overweight individuals. The population attributable fractions in men and women aged 40 to 64 years receiving an intensive support intervention were 17.7% and 6.6%, respectively, while that in women aged 65 to 74 years receiving a motivation-support intervention was 9.4%. Compared with the supernormal group, nonobese/overweight individuals with risk factors had similar hazard ratios and population attributable fractions as individuals with metabolic syndrome.

Original languageEnglish
Article numbere020760
JournalJournal of the American Heart Association
Volume10
Issue number23
DOIs
Publication statusPublished - 2021 Dec 7
Externally publishedYes

Keywords

  • Cardiovascular disease
  • Cohort study
  • Incidence
  • Metabolic syndrome
  • Risk classification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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