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ISSN 1561-3186 (Electronic)

2021, Number 4

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Rev Acta Médica 2021; 22 (4)

Utility of metabolic syndrome diagnostic classifications to detect vascular damage and insulin resistance

Concepción QF, Calderin BRO, Tamargo BTO, Yanes QMÁ, Yanes QM

Language: Spanish
References: 30
Page: 1-18
PDF size: 598.70 Kb.


ABSTRACT

Purpose: To evaluate the usefulness of metabolic syndrome diagnostic classifications for diagnosis of insulin resistance and vascular damage in patients with atherogenic dyslipidemia.
Methods: A cross-sectional analytical study was performed with 2362 patients with atherogenic dyslipidemia who met selection criteria, between June 2017 and June 2019. Insulin resistance was estimated through the IR-HOMA index. Criteria for atherogenic dyslipidemia increased total triglycerides and/or decreased high-density lipoprotein. Vascular damage criteria, presence of thickening of the carotid intima media complex, left ventricular hypertrophy and chronic kidney disease. Sensitivity, specificity and predictive values for detecting insulin resistance and vascular damage were estimated.
Results: After the comparison of the three diagnostic classifications, it was shown that there were significant differences between patients with and without insulin resistance. Being the WHO classification with 79.8% the one with the highest number of cases identified with insulin resistance and metabolic syndrome, in addition, there were significant differences between patients with and without vascular damage. The WHO presented a greater distribution of patients with vascular damage 77.8%; followed by the IDF with 73.4% and finally the NECP-ATPIII 65.8%. For the detection of insulin resistance and vascular damage according to the different classifications, their validity indicators were estimated. All with adequate sensitivity, but WHO was the highest with insulin resistance 79.8% and vascular damage 77.9%. The one with the highest specificity was the NCEP-ATPIII with 72.2%, in relation to the IDF and the WHO, although within acceptable values. With regard to PPV, there were no major differences. The highest NPV was the WHO with insulin resistance 77.8% and according to vascular damage 96.6% followed by the IDF and NCEP-ATPIII.
Conclusions: The three diagnostic classifications, WHO, NCEP and IDF, are useful for diagnosing metabolic syndrome and insulin resistance, high sensitivity for detecting vascular damage, but with low specificity, acceptable PPV and high NPV. We consider that the WHO and IDF classifications are the most useful for diagnosing insulin resistance and vascular damage because of their high sensitivity, acceptable PPV and high NPV.


REFERENCES

  1. Calderín B, Monteagudo P, Yanes QM, García SJ, Marichal MS, Cabrera RE, et al. Síndrome metabólico y prediabetes. Rev Cubana Endocrinol. 2011 [acceso: 02/05/2020];22(1):52-7. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1561-29532011000100010&lng=es.

  2. Ruiz GA, Arranz ME, Morón MI, Pascual FV, Tamarit JJ, Trias VF, et al. Documento de consenso de la Sociedad Española de Arteriosclerosis (SEA) para la prevención y tratamiento de la enfermedad cardiovascular en la diabetes mellitus tipo 2. Clín Investig Arterioscler. 2018;30:1-19. DOI: https://doi.org/10.1016/j.arteri.2018.06.006

  3. Adeva A, Martínez RJ, González LM, Fernández FC, Castro QE. Insulin resistance is a cardiovascular risk factor in humans. Diabetes Metab Syndr. 2019;13(2):1449-55. DOI: http://doi.org/10.1016/j.dsx.2019.02.023

  4. Ascaso JF, Millán J, Hernández MA, Blasco M, Brea A, Díaz A, et al. Dislipidemia aterogénica 2019. Documento de consenso del Grupo de Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis. Clín Investig Arterioscler. 2020. DOI: https://doi.org/10.1016/j.arteri.2019.11.004

  5. Frías VM, Pallarés CV, Díaz RA, Cinza SS, Prieto DA, García VA, et al. The cardiometabolic characteristics of the premorbid metabolic syndrome in women, data from the IBERICAN study. Atherosclerosis. 2018;275: e212-3. DOI: https://doi.org/10.1016/j.atherosclerosis.2018.06.665

  6. Díaz RÁ, Blasco VM, Mantilla MT, Capón AJ, Rodríguez de MM, Rodríguez F, et al. Management of atherogenic dyslipidemia in the primary care setting in Spain. Clin Investig Arterioscler. 2019;31(5):203-9. DOI: http://doi.org/10.1016/j.arteri.2019.03.001

  7. Rodríguez FP, Blasco VM, Díaz RA, Orera PL. Management of cardiovascular risk and treatment in patients with atherogenic dyslipidemia. Perspective of primary care physicians. AVANZA study. Atherosclerosis. 2018;275:e223. DOI: https://doi.org/10.1016/j.atherosclerosis.2018.06.704

  8. Rodríguez AD, Cumplido AS, Nuñez C, Rodríguez de Miguel M, Orera ML. The application of atherogenic dyslipidaemia consensus recommendations in the primary care setting. DAT-AP study. Clin Investig Arterioscler. 2017;29(4):178-84. DOI: http://doi.org/10.1016/j.arteri.2017.04.003

  9. Carbayo H, Simarro RM, Palazón A, Molina EF, Ponce GI, Artigao R, et al. Valoración del colesterol no HDL como predictor de episodios cardiovasculares no mortales en una cohorte prospectiva de origen poblacional. Clín Investig Arterioscler. 2018;30(2):64-71. DOI: https://doi.org/10.1016/j.arteri.2017.10.003

  10. Millán J, Hernández A, Ascaso JF, Blasco M, Brea A, Díaz A, et al. La auténtica dimensión del colesterol-no-HDL: colesterol aterogénico. Clín Investig Arterioscler. 2016;28(6): 265-70. DOI: https://doi.org/10.1016/j.arteri.2016.05.002

  11. Janczura M, Konduracka E, Gielicz A, Kotula K, Iwaniec T, Stanisz A, et al. Oxidative stress is associated with insulin resistance and the left ventricular hypertrophy in the middle-aged subjects with metabolic syndrome. Atherosclerosis. 2017;263:e253. DOI: https://doi.org/10.1016/j.atherosclerosis.2017.06.821

  12. Barazzoni R, Gortan G, Semolic A, Ius M, Zanetti M, Gabrielli A, Vinci P, et al. Central adiposity Markers, plasma lipid profile and cardiometabolic risk prediction in overweight-obese individuals. Clin Nutr. 2019;38(3):1171-9. DOI: https://doi.org/10.1016/j.clnu.2018.04.014

  13. Maximus PS. Insulin like growth factor 1 is linked to higher cardiovascular risk score in adults with type 2 diabetes mellitus and chronic kidney disease. Diabetes & Metab Syndr. 2019;13(4):2613-8. DOI: https://doi.org/10.1016/j.dsx.2019.07.008

  14. Oransky I, Marcus A, Gerald R. The Lancet. The Lancet. 2018;391(10131):e19. DOI: https://doi.org/10.1016/S0140-6736(18)30906-1

  15. Lambrinoudaki I, Kazani MV, Armeni E, Georgiopoulos G, Tampakis K, Rizos D, et al. The TyG Index as a Marker of Subclinical Atherosclerosis and Arterial Stiffness in Lean and Overweight Postmenopausal Women. Heart Lung Circ. 2018;27(6):716-24. DOI: http://doi.org/10.1016/j.hlc.2017.05.142

  16. Masson W, Siniawski D, Lobo M, Molinero G, Huerin M. Asociación entre la razón triglicéridos/colesterol HDL y ateromatosis carotídea en mujeres posmenopáusicas de mediana edad. Endocrinol Nut. 2016;63(7):327-32. DOI: https://doi.org/10.1016/j.endonu.2016.04.004

  17. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082-e1143. DOI: http://doi.org/10.1161/CIR.0000000000000625.

  18. Alberti KG, Zimmet P. Shaw J. Metabolic syndrome-a new worldwide definition. A Consensus Statement from the Diabetes Federation. Diabet Med. 2006;23(5):469-80. DOI: https://doi.org/10.1111/j.1464-5491.2006.01858.x

  19. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA;285(19):2486-97. DOI: http://doi.org/10.1001/jama.285.19.2486

  20. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al; A Joint Interim Statement of the Diabetes Federation Task Force on Epidemiology and Prevention; Hational Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Circulation. 2009;120(16):1640-5. DOI: http://doi.org/10.1161/CIRCULATIONAHA.109.192644

  21. Fernández BD, Félix R, Lozano L, Pérez C, Sanz H, Cabrera LA, et al. Prevalencia de síndrome metabólico según las nuevas recomendaciones de la OMS: Estudio HERMEX. Gac Sanit. 2011 [acceso: 02/05/2020];25(6):519-24. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-91112011000600014&lng=es

  22. Janczura M, Kotula K, Iwaniec T, Stanisz A, Dropinski J, Domagala T. Association of insulin resistance, as determined by homeostasis model assessment (HOMA), with metabolic syndrome among middle-aged subjects. Atherosclerosis. 2016;252:e135. DOI: http://dx.doi.org/10.1016/j.atherosclerosis.2016.07.685

  23. Belhayara MI, Mellouk Z, Hamdaoui MS, Bachaoui M, Kheroua O, Malaisse WJ. Relationship between the insulin resistance and circulating predictive biochemical markers in metabolic syndrome among young adults in western Algeria. Diabetes Metab Syndr. 2019;13(1):504-9. DOI: https://doi.org/10.1016/j.dsx.2018.11.019

  24. Mente A, Yusuf S, Islan S, McQueen MJ, Tanomsup S, Onen CL, et al. Metabolic syndrome and risk of acute myocardial infarction a case control study of 26,903 subjects from 52 countries. J Am Coll Cardiol. 2010;55(21):2390-8. DOI: https://doi.org/10.1016/j.jacc.2009.12.053

  25. Caixàs A, Villaró M, Arraiza C, Montalvá JC, Lecube A, Fernández JM, et al. Documento de consenso de la Sociedad Española de Obesidad (SEEDO) y de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN) sobre la continuidad asistencial en obesidad entre Atención Primaria y Unidades Especializadas Hospitalarias 2019. Med Clín. 2020;155(6):e267. DOI: https://doi.org/10.1016/j.medcli.2019.10.014

  26. Manu P, Tsang J, Napolitano BA, Lesser ML, Correll CU. Predictors of insulin resistance in the obese with metabolic syndrome. Eur J Intern Med. 2010; 21(5):409-13. DOI: https://doi.org/10.1016/j.ejim.2010.05.015

  27. Standards of Medical Care in Diabetes 2020. ADA Clinical Practice Recommendations. Diabetes Care. 2020;43(3):501-7. DOI: https://doi.org/10.2337/cd20-as01

  28. Villalobos SA, Millán GG, Narankievickz D. Síndrome metabólico. Programa de Formación Médica Continuada Acreditado. 2017;12(42):2485-93. DOI: https://doi.org/10.1016/j.med.2017.10.002

  29. Ruiz García A, Arranz Martínez E, Morón Merchante I, Pascual Fuster V, Tamarit JJ, Trias Villagut F, et al. Documento de consenso de la Sociedad Española de Arteriosclerosis (SEA) para la prevención y tratamiento de la enfermedad cardiovascular en la diabetes mellitus tipo 2. Clín Investig Arterioscler. 2018;30(Supple 1):1-19. DOI: https://doi.org/10.1016/j.arteri.2018.06.006

  30. Pedro BJ, Ascaso JF, Blasco M, Brea A, Díaz A, Hernández MA, et al. Triglicéridos, colesterol HDL y dislipidemia aterogénica en la guía europea para el control de las dislipidemias 2019. Clin Invest Aterocler. 2020;32(5):209-18. DOI: https://doi.org/10.1016/j.arteri.2019.12.003




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