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Sindrome metabolica e incidenza di malattia cardiovascolare. Lo studio ATTICA

Molti l'hanno contestata e molti sono stati i modelli proposti per la sua definizione clinica. I criteri più frequentemente seguiti per la definizione di sindrome metabolica sono quelli elaborati dal National Cholesterol Education Program (NCEP) e dall'International Diabetes Federation (IDF) che si basano sugli stessi fattori, circonferenza della vita, trigliceridi, colesterolo HDL, pressione arteriosa e glicemia, ma con pesi diversi. Gli autori hanno voluto verificare su oltre 2.500 pazienti seguiti per 10 anni, il peso predittivo della sindrome metabolica definita secondo NCEP, IDF e secondo un nuovo modello armonizzato, sempre basato sugli stessi fattori, che si pone come intermedio tra NCEP e IDF. La conclusione è stata che solo il modello NCEP è risultato significativamente associato allo sviluppo di malattia cardiovascolare.

Metabolic syndrome and 10-year cardiovascular disease incidence: The ATTICA study

Kastorini CM, Panagiotakos DB, Georgousopoulou EN, Laskaris A, Skourlis N, Zana A, Chatzinikolaou C, Chrysohoou C, Puddu PE, Tousoulis D, Stefanadis C, Pitsavos C; ATTICA Study Group

Nutr Metab Cardiovasc Dis 2016;26:223-231

AIMS: To evaluate the influence of metabolic syndrome (MetS) as well as inflammatory and renal markers on cardiovascular disease (CVD) incidence.
METHODS AND RESULTS: During 2001-2002, 1514 men and 1528 women (>18 y) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, Greece, were enrolled. In 2011-2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. MetS was defined using three definitions, provided by the National Cholesterol Education Program Adult Treatment panel III (revised NCEP ATP III), the International Diabetes Federation (IDF) or the Harmonized definition. Furthermore, the contributory predictive role of C-reactive protein (CRP), inteleukin-6, uric acid and estimated glomerular filtration rate in the aforementioned models was evaluated. History of MetS-NCEP was positively associated with CVD, adjusting for potential confounding factors (OR:1.83, 95%CI:1.24-2.72). Not statistically significant associations with CVD incidence were observed when using the IDF or the Harmonized definition. Additionally, none of the added inflammatory and renal function markers mediated the influence of MetS on CVD incidence (all p's from Sobel test >0.40). C-statistic values for the MetS definitions used exceeded 0.789 (CI:0.751-0.827), indicating fair-to-good predictive probability of the models.
CONCLUSION: Results of the present work revealed the negative impact of MetS-NCEP, but not of the other MetS definitions, on CVD incidence, a key-point that may help in better understanding the role of IDF and Harmonized MetS definitions on CVD.

Nutr Metab Cardiovasc Dis 2016;26:223-231