As the United States faces an epidemic of obesity and type 2 diabetes, cardiovascular disease (CVD) remains the nation's leading cause of death. The common thread linking obesity, insulin resistance, type 2 diabetes, and CVD is the metabolic syndrome (MS). However, thresholds of MS variables associated with CVD risk need to be reexamined in light of ethnic variation noted by previous investigators. Thus, we have commenced examination of distribution of metabolic factors as influenced by race.
Methods The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective observational study of 6,814 participants aged 45 to 84. Four ethnic groups were observed: Caucasian, Chinese, African American, and Hispanic. We examined data derived from the baseline examination and used JMP 5.1 software for data management and statistical analysis. We calculated participants' HOMA IR (homeostatic model of insulin resistance) and noted interracial triglyceride variation in a subpopulation of high insulin resistance. We thus redefined the MS threshold of hypertriglyceridemia and examined the subpopulation who met the new MS criteria.
Results The redefined metabolic triglyceride criterion (TG = 115 mg/dL) resulted in improved sensitivity with reduced interracial variability. Furthermore, this newly defined population continued to have elevated markers of subclinical atherosclerosis, similar to those patients with the classic definition of MS.
Conclusion We have suggested altered criterion for one MS variable and continue to model similar threshold alterations in other variables. Using racially sensitive thresholds for metabolic variables, we hope to arrive at a more universally applicable definition of the MS with maximum sensitivity, specificity, and minimal interracial variation.
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