Empirical Derivation to Improve the Definition of the Metabolic Syndrome in the Evaluation of Cardiovascular Disease Risk

OBJECTIVE: To examine whether a quantitatively derived metabolic syndrome definition predicts incident cardiovascular disease (CVD) events better than do existing definitions. RESEARCH DESIGN AND METHODS: Data were pooled from the Atherosclerosis Risk in Communities, Cardiovascular Health, and Framingham Offspring studies (n = 20,581). Incident coronary heart disease and stroke events were ascertained over 9 years. RESULTS: The sensitivity for incident CVD events was higher and the specificity lower for the empirically derived versus the Adult Treatment Panel (ATP) III, International Diabetes Federation (IDF), or Harmonized metabolic syndrome definitions (sensitivity/specificity 0.65/0.53 vs. 0.53/0.63, 0.51/0.66, and 0.64/0.56, respectively), resulting in no overall improvement in discrimination. Multivariable-adjusted hazard ratios for incident CVD events were similar across definitions and were 1.7 (95% CI 1.6–1.9) for ATP III, 1.8 (1.6–2.0) for IDF, 1.9 (1.7–2.0) for Harmonized, and 1.7 (1.6–1.9) for the empirically derived definition. CONCLUSIONS: Empirical derivation of the metabolic syndrome definition did not improve CVD discrimination or risk prediction.