In part as a result of an obesity epidemic, the prevalence of the “metabolic syndrome” is greater than previously believed. However, despite growing public and professional attention to the condition, estimates of its overall prevalence vary widely. Because of the potential impact of this syndrome on VA health care, we wished to ascertain the prevalence in the VANCHCS using the VA computerized clinical database. To do so, we modified the ATPIII criteria, keeping fasting blood glucose (FBS), blood pressure, triglyceride, and HDL cholesterol criteria but substituting BMI ≥ 30 for waist:hip ratio. We also accepted current pharmacotherapy for diabetes as qualifying for elevated FBS; current therapy with niacin, gemfibrozil, or fenofibrate for elevated triglyceride; and recent use of multiple ICD-9 codes for hypertension for elevated blood pressure. We examined all clinical records between July 1, 2004 and June 30, 2005 for veterans registered in VANCHCS who filled any prescription during this interval (n = 51,026). Their average age was 63 years; 93% were male. Twenty-five percent (n = 13,010) were diagnosed as having metabolic syndrome by meeting at least three of the above 5 criteria. Since only 60% (n = 30,727) of the population had data for 3 or more criteria, the actual percent with metabolic syndrome is probably substantially higher. We conclude that over one-quarter of our veterans in the VANCHCS may have metabolic syndrome based on our modified ATPIII criteria. We need to be screening more of our veterans with fasting laboratory testing. This computerized screening of a large clinical database can then provide an effective strategy to aid clinicians in identifying more patients at risk for cardiovascular disease.
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