Components of Metabolic Syndrome and their Combinations as Predictors of Cardiovascular Disease in Japanese Patients with Type 2 Diabetes. Implications for Improved Definition. Analysis from Japan Diabetes Complications Study (JDCS)

Aim: The prognostic power of metabolic syndrome (MetS) in patients with diabetes has been studied with inconsistent results depending on the definition of MetS. To clarify the best combination of MetS components to predict future cardiovascular disease (CVD) events, we estimated CVD risk in Japanese patients with type 2 diabetes according to MetS components. Methods: Patients were categorized according to the presence three MetS components in addition to hyperglycemia. hypertension, dyslipidemia and excess waist circumference (WC) (according to either Japanese or Asian cut-off values). Hazard ratios for CVD events were compared in patients with various categories of MetS components. Results: At least two components of MetS were required for a significantly elevated risk for CVD; however, component combinations with significantly increased risk differed depending on gender or the WC cut-off value. Any two among 1) excess WC (men >= 90 cm, women >= 80 cm); 2) hypertension (systolic blood pressure >= 130 mmHg or diastolic blood pressure >= 85 mmHg or use of an antihypertensive agent); and 3) dyslipidemia (triglycerides >= 150 mg/dL or HDL-cholesterol < 40 mg/dL or use of drug treatment) could be used to identify significantly higher risk (approximately twice) for CVD regardless of gender. Conclusions: The results suggest that the current MetS criteria should be modified when applied to patients with type 2 diabetes.