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CHD Prevalence in Americans Age 50 Years and Older Using NCEP and WHO Definitions of Metabolic Syndrome

The World Health Organization (WHO) criteria for metabolic syndrome were originally published in 1998 and subsequently revised in 1999. The National Cholesterol Education Program (NCEP) proposed somewhat different criteria for the metabolic syndrome in 2001. This study compares the NCEP and WHO criteria for metabolic syndrome with respect to prevalence of coronary heart disease (CHD) in those 50 years and older. The Third National Health and Nutrition Examination Survey (NHANES III) was used to classify adults (> 50 years) by metabolic syndrome using NCEP and 1999 WHO definitions. Risk factor information for components of the metabolic syndrome, traditional cardiovascular risk factors and the prevalence of CHD were determined for each group. Individuals 50 years and older meeting only NCEP criteria had more traditional cardiovascular risk factors than those only meeting WHO criteria and less insulin resistance, per se. Consequently, the NCEP‐only group had a greater prevalence of CHD (18.8%) compared to the WHO‐only group (12.6%, p < 0.001). As a whole (including all individuals who met either NCEP or WHO criteria), prevalence of CHD was significantly higher in those meeting the NCEP definition (15.5%) compared to those meeting the WHO definition of metabolic syndrome (14.1%, p < 0.001). In conclusion, many individuals 50 years and older meet both NCEP and WHO criteria for metabolic syndrome (i.e., there is substantial concordance between the two criteria) and both criteria identify individuals with insulin resistance. NCEP criteria identified individuals with significantly higher CHD prevalence compared to the WHO criteria. In spite of the fact that individuals who met only the WHO criteria were more insulin resistant than the NCEP‐only individuals, those who met only the NCEP clinical criteria for metabolic syndrome had a much worse cardiovascular risk profile and were more likely to have prevalent CHD than those who met only the WHO criteria.