Sex- and Ethnic-Specific Screening Tools

New screening tools for metabolic syndrome may better identify patients at risk for diabetes and heart disease

A new sex- and ethnicity-specific tool for assessing the risk for metabolic syndrome may better identify people at highest risk for developing type 2 diabetes and cardiovascular disease for whom targeted interventions may be warranted. The findings were presented at The Endocrine Society’s 95th Annual Meeting, held in San Francisco, California.

“We are hopeful that this score will be a convenient tool for treating physicians, an outcome to be followed for clinical research studies, and most importantly a motivator to patients to improve their score and decrease their long-term risk,” said lead author Mark D. DeBoer, MD, Associate Professor of Pediatrics at the University of Virginia Health System in Charlottesville.

“Current criteria for diagnosing metabolic syndrome are based on individuals having abnormalities outside the normal range for specific cardiovascular risk components,” Dr. DeBoer explained. “However, the normal range is based on the population as a whole, while some sex- and racial/ethnic groups are less likely to exhibit abnormalities in a given component. African Americans in particular are less likely to have lipid abnormalities related to the metabolic syndrome and are thus less likely to be diagnosed with the metabolic syndrome despite having more type 2 diabetes and higher cardiovascular mortality. We interpreted these and other data to suggest that the metabolic syndrome may manifest differently in different racial/ethnic groups,” he said.

How the Tool Was Developed

Dr. DeBoer and his colleague Matthew Gurka, PhD, examined data from 6,881 men and women who participated in the National Health and Nutrition Examination Survey between 1999 and 2010. Components of metabolic syndrome clustered together in different ways between gender and racial-ethnic groups. The authors assigned numeric values to each of the five metabolic syndrome components (waist circumference, blood pressure, glucose, triglyceride level, and high-density lipoprotein cholesterol [HDL] level), with each component having a different weight for each sex and racial-ethnic group. In African-American men, for example, HDL cholesterol level received a higher weighting than blood pressure, indicating it may be more predictive of worsening metabolic syndrome. In women, waist circumference had a higher weighting in African Americans than in whites.

The tool was validated against other cardiovascular risk factors such as C-reactive protein and a model of insulin resistance. “However, the benefit of this score in clinical practice will be strengthened by validation as a predictor of future disease,” Dr. DeBoer noted. “Once this is done, clinicians will be able to use the score to evaluate the degree of metabolic syndrome severity in a given patient, following the score over time as a way to evaluate for improvement due to treatment—or worsening as a potential sign for impending disease. Our current research projects will help determine thresholds of future risk associated with specific score values.”

Expert Commentary

“Subsegmenting patient populations to target therapy is important in ensuring that therapies overall are more effective,” commented Tamara L. Wexler, MD, endocrinologist and attending physician at Massachusetts General Hospital in Boston, and managing director of a group dedicated to optimizing the public health impact of biomedical discoveries. “It is important to look at gender, ethnicity, and other differences between patients to establish guidelines for care as well as to target treatments,” she noted.

Dr. Wexler called the study intriguing and noted that a strength of the research is that it involved a large database. “It will be interesting to read the full paper,” she said.

In terms of guidelines, the authors look appropriately at markers of disease, said Dr. Wexler, who also is a spokesperson for The Endocrine Society. She concurred with Dr. DeBoer, saying “The one thing that remains to be validated is that those markers reliably predict disease in these populations."

This score is currently under review for publication. Drs. DeBoer and Gurka also are in the process of designing a Website that will make application of the score easier for treating physicians and their patients.

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