[health-vn] Optimal waist measurements predict CVD in Japanese
vern.weitzel at gmail.com
Thu May 7 08:40:42 EST 2009
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,
Reviewer: Carlos Mendoza Montano, PhD, ProCor contributing editor; President,
Guatemalan Association for the Prevention of Heart Diseases (APRECOR), 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
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.
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.
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