Assessing Baseline and Temporal Changes in Cardiometabolic Risk Using Metabolic Syndrome Severity and Common Risk Scores

BACKGROUND: Type 2 diabetes mellitus (T2DM) is considered a cardiovascular disease (CVD) risk equivalent, thereby linking assessment of cardiometabolic risk with that of CVD risk over time. Our goal was to determine how commonly used CVD risk scores and metabolic syndrome (MetS) severity performed in predicting T2DM with and without ultimate CVD. METHODS AND RESULTS: We assessed data from 8273 participants of the ARIC (Atherosclerosis Risk in Communities) Study, using the pooled cohort atherosclerotic CVD risk score, the Framingham Risk Score, and a MetS severity Z score to assess their association with future risk for CVD alone, T2DM alone, or both over 20 years of follow‐up. Baseline levels of all scores were significantly associated with isolated incident T2DM (odds ratios [ORs] for each 1‐SD increase: atherosclerotic CVD=1.7, Framingham risk score=1.7, MetS Z score=5.1). All 3 baseline scores were also significantly associated with isolated incident CVD (atherosclerotic CVD OR=2.4, Framingham risk score OR=2.3, MetS Z‐score OR=1.8), with the 2 CVD scores remaining significant independent of MetS severity. MetS severity was strongly associated with future T2DM leading to CVD (MetS Z‐score OR=7.0, atherosclerotic CVD OR=3.9, Framingham risk score OR=3.5). Furthermore, changes in MetS severity were independently associated with future T2DM‐CVD progression. CONCLUSIONS: CVD risk scores are associated with risk for future isolated T2DM in addition to isolated CVD. However, MetS severity (both baseline and changes over time) was more strongly associated with T2DM, including T2DM ultimately leading to CVD. Following MetS severity within patients over time may identify those at greatest risk of combined cardiometabolic disease.