Comparison of the Three Most Commonly Used Metabolic Syndrome Definitions in the Chinese Population: A Prospective Study

Metabolic syndrome (MetS) is associated with cardiovascular risk, and there are various definitions, but which is most predictive of future cardiovascular disease (CVD) in the Chinese population is still unclear. MetS was defined with the revised ATP III (Third Adult Treatment Panel Report), International Diabetes Federation (IDF), and the Joint Committee for Developing Chinese Guidelines (JCDCG) definitions. Cox regression was used to estimate the hazard risk of cardiovascular disease among 20,888 participants using the Chinese Hypertension Survey (CHS) data. Sensitivity, specificity, and receiver operating characteristic (ROC) curve distance were used to test the ability of three MetS criteria to identify CVD. During an average follow-up of 4.89 years of 20,888 participants, 925 CVD events occurred (stroke, 560; coronary heart disease, 275; and other cardiovascular events, 119). The revised ATP III criteria identified the most individuals with MetS and had the highest prevalence of MetS. In addition, MetS was associated with a high risk of CVD in both men and women, according to three criteria. The highest diagnostic specificity was for IDF in men and JCDCG in women. The revised ATP III criteria had the highest sensitivity and shortest ROC curve distance in both men and women. Although the MetS definitions, including the revised ATP III, IDF, and JCDCG, are all related to the increased risks of CVD, overall, the revised ATP III performs best and is the most recommended for the Chinese population.