Online metabolic syndrome severity calculator may predict coronary heart disease

Researchers have developed an online metabolic syndrome severity calculator that could predict coronary heart disease better than traditional methods.

Their severity score incorporates the five components of the metabolic syndrome: waist circumference, systolic blood pressure, fasting triglycerides, high-density lipoprotein and fasting glucose. Unlike the Adult Treatment Panel III (ATP-III) metabolic syndrome classification, their calculator also adjusts for sex, race and ethnic differences.

Lead researcher Mark D. DeBoer, MD, MSc, MCR, of the University of Virginia, and colleagues published their results online in the Journal of the American College of Cardiology on March 29.

DeBoer and Matthew J. Gurka, PhD, developed the metabolic syndrome severity calculator. It differentiates between adolescents from 12 to 19 years old and adults who are 20 years old or older.

“The hope is that a scoring system like this could be incorporated in the electronic medical record to calculate someone's risk and that information could be provided both to the physician, who then realizes there is an elevated risk, and to the patient, who hopefully can start taking some preventative steps,” DeBoer said in a news release.

If patients have abnormalities in three of five components of the metabolic syndrome, they are often told they have an increased risk for cardiovascular disease, type 2 diabetes and stroke, according to the researchers. However, that may not always be accurate.

"As is true in most processes in life, the reality is that this risk exists on a spectrum," DeBoer said in a news release. "Someone who has values in each of these individual risk factors that are just below the cutoff still has more risk for future disease than somebody who has very low values."

For this analysis, the researchers evaluated adjudicated coronary heart disease outcomes from the ARIC (Atherosclerosis Risk in Communities) study and the JHS (Jackson Heart Study).

The ARIC study enrolled 11,004 white and black participants from 1987 to 1989 and followed them for 24 years or less. The mean age was 53.8 years old. The JHS enrolled 2,137 black participants from 2000 to 2004 and followed them 11 years or less. The mean age was 48.5 years old.

Using Cox proportional hazards models, the researchers assessed how the ATP-III metabolic syndrome classification and their metabolic syndrome severity scores helped predict coronary heart disease and compared them to the Fine and Gray model.

The researchers found that the ATP-III metabolic syndrome classification was significantly associated with future coronary heart disease. However, after adjusting for the metabolic syndrome components, the classification was not associated with future coronary heart disease. Meanwhile, the metabolic syndrome severity score was associated with future coronary heart disease in models with and without the individual components.

The time-dependent area under the curve was 0.56 for ATP-III metabolic syndrome classification and 0.63 for the metabolic syndrome score.

Unlike the ATP-III, the metabolic syndrome severity calculator did not have differences in coronary heart disease prediction based on sex or race.

“Overall, the [metabolic syndrome severity calculator] performed better than and appeared to offer multiple advantages over ATP-III [metabolic syndrome] classification in [coronary heart disease] risk prediction. Cutoff values indicating particular increase in [metabolic syndrome] severity–related risk are still needed.”