Editorial
New Criteria for Metabolic Syndrome: Evaluation of its Effectiveness and Economy for Screening will be Needed
2024 Volume 31 Issue 4 Pages 349-350
Details
2024 Volume 31 Issue 4 Pages 349-350
See article vol. 31: 382-395
Yamazaki Y et al.1) developed a new criteria for metabolic syndrome to predict cardiovascular diseases in Japanese. Using the claim database of approximately 570,000 large company employees aged 18–74 years without a history of coronary artery disease or cerebrovascular disease, they found that the new criteria captured high-risk individuals, especially women, although the prediction for cardiovascular diseases was similar among the new, existing Japanese, IDF, and modified NCEP ATP Ⅲ criteria.
The new criteria has two ways of optimization (i.e., high waist circumference [WC] as well as ≥ 2 other metabolic components and ≥ 3 metabolic components) using the following cut points: WC (≥ 83 cm in men and ≥ 77 cm in women), dyslipidemia (triglycerides ≥ 130 mg/dL and/or HDL-cholesterol ＜50 mg/dL in men and ≥ 90 and/or ＜65 mg/dL, respectively in women, or on drug treatment), high blood pressures (systolic ≥ 130 mmHg and/or diastolic ≥ 80 mmHg in men and ≥ 120 mmHg and/or ≥ 80 mmHg, respectively in women, or no drug treatment), and high glucose (≥ 100 mg/dL in men and ≥ 90 in women or previously diagnosed type 2 diabetes). The optimized criteria showed a higher sensitivity and lower specificity (especially for women) than the Japanese criteria. The net reclassification improvement for evaluating improvements in risk prediction for the two optimized criteria was 5–8% in men and 18–20% in women. The authors concluded that the optimized criteria yielded better prediction for cardiovascular diseases compared to the existing criteria.
The authors provided informative evidence to reconsider the criteria for metabolic syndrome. However, we need to interpret the findings with care. First, the age range of the target population used for the analysis was 18–74 years but not 40–74 years, for which a nationwide program is applied on screening and lifestyle intervention for the prevention and control of metabolic syndrome. The younger ages of 19–39 were used for the analysis. Second, the database used for the analysis was the data on large company employees with no inclusion of intermediate or small company employees and self-employees2). The distributions of metabolic risk factors and related lifestyle may differ among the age groups or employment status. In particular, the younger age group may have lower levels of waist circumference and other metabolic risk factors than the older one3). Third, the prediction by the optimized criteria was improved especially for women, but we need to consider the lower absolute risk (approximately one-third) of cardiovascular disease among women than among men. Thus, the application of the optimized criteria to the existing program would likely lead to the overloading of the program for prevention and medical treatment among women. The evaluation of effectiveness and economy should be considered. Finally, smoking is needed for risk classification so that the investigation like the previous study4) using the optimized criteria applying to the existing program framework may be useful.
Nevertheless, the authors raised a question in the argument on the better criteria for metabolic syndrome in Japanese.
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