[health-vn] Optimal waist measurements predict CVD in Japanese

[Vern Weitzel]

Subject: [procor] Optimal waist measurements predict CVD in Japanese
Date: Mon, 04 May 2009 09:40:44 -0400
From: ProCor <procor at procor.org>
Reply-To: Global Dialogue <procor at list.procor.org>
To: Global Dialogue <procor at list.procor.org>
[Learn more about the relationship between waist measurement and CVD risk by 
searching ProCor’s website: www.procor.org.]

Optimal waist circumference cutoff points for metabolic syndrome criteria, 90 cm 
in men and 80 cm in women, are the strongest predictors of CVD events in Japanese...

Title: Proposed criteria for metabolic syndrome in Japanese based on prospective 
evidence: The Hisayama Study

Authors: Y Doi, T Ninomiya, J Hata, K Yonemoto, H Arima, et al.

Reference: Stroke 2009; 40: 1187-1194, 
http://stroke.ahajournals.org/cgi/content/abstract/40/4/1187

Reviewer: Carlos Mendoza Montano, PhD, ProCor contributing editor; President, 
Guatemalan Association for the Prevention of Heart Diseases (APRECOR), Guatemala 
City, Guatemala

Problem addressed: Metabolic syndrome (MetS) consists of a clustering of 
cardiovascular risk factors, and individuals with this condition have an 
elevated risk of developing cardiovascular disease (CVD) and type 2 diabetes. 
Practical and valuable criteria must be established promptly because the 
prevalence of MetS has been increasing rapidly in recent years in Japan and 
other countries. For Japanese, two sets of diagnostic criteria of MetS exist at 
the present time, resulting in a great deal of confusion in clinical practice. 
In one set, waist circumference is defined as an essential component, and its 
cutoff value is 85 cm for men and 90 cm for women. In the other set, waist 
circumference cutoff points levels of 90 cm in men and 80 cm in women are used 
as a requirement of diagnosis. It remains unclear which of these criteria or 
cutoff points of waist circumference are a better predictor for CVD in the 
general population of Japanese.

Purpose of study: To derive a better definition from the existing MetS criteria 
for predicting CVD in a prospective study of a defined general population of 
Japanese.

Location of study: Japan

Study design: In a 14-year follow-up study of 2452 community-dwelling Japanese 
individuals aged 40 years and older, the investigation examined which of the 
MetS criteria are most predictive for the development of CVD. The subjects were 
followed prospectively from December 1988 to November 2002 by repeated health 
examinations. Health status was checked yearly. CVD was defined as the 
development of ischemic stroke or coronary heart disease.

Results: An optimal cutoff point of waist circumference for predicting CVD was 
90 cm in men (age-adjusted hazard Ratio = 1.81) and 80 cm in women (age-adjusted 
hazard ratio = 1.46). A comparison of MetS criteria showed that the modified 
Japanese criteria using this cutoff point instead of the original definition 
were the strongest predictor of CVD events in both sexes (men: age-adjusted 
hazard ratio=2.58, women: age-adjusted hazard ratio= 2.39). These observations 
remained robust even after adjustment for other confounding factors. According 
to this set, only in the presence of central obesity, the hazard ratios for 
future CVD increased significantly as the number of MetS components increased, 
and a significant relationship was identified from two or more MetS components 
compared with individuals who had no MetS component.

Comments: The present analysis has clearly demonstrated that the optimal cutoff 
point of waist circumference is 90 cm in men and 80 cm in women and that the 
modified Japanese criteria of MetS with this cutoff point as an essential 
component better predicted CVD in the general Japanese population than did the 
other criteria sets. Furthermore, the increasing effects of MetS on the 
development of ischemic stroke and coronary heart disease were independent of 
hypertension and diabetes. According to the authors of the study, high-risk 
strategies using this criteria set offer additional protection against CVD.

Citations:
1. Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes 
associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 
2005; 28: 1769-1778.
2. Ohmura T, Ueda K, Kiyohara Y, Kato I, et al. Prevalence of type 2 
(non-insulin-dependent) diabetes mellitus and impaired glucose tolerance in the 
Japanese general population: The Hisayama Study. Diabetologia 1993; 36: 1198 -1203.