Metabolic syndrome in Internal Medicine patients: the pilot NIMEC study (National Internal Medicine Equivalent/Complex C-V-@Risk)

BACKGROUND Metabolic Syndrome (MetS), currently defined as slight differences in the criteria of diagnosis - depending on which authority is quoted [i.e.: NCEP-ATP III (National Cholesterol Education Program/Adult Treatment Panel III); WHO (World Health Organization); IDF (International Diabetes Federation); AACE (American Association of Clinical Endocrinologists)], designates a cluster of metabolic risk factors that come together in a single individual, leading to cardiovascular disease. MetS is quite common, approximately 20-30% of the population in industrialized countries being affected. However, most of epidemiological data regarding MetS are derived from populations consisting mostly of middle-aged and younger subjects.
AIM OF THE STUDY To assess the prevalence of the MetS in Internal Medicine wards and to determine its related comorbidities, including other clinical forms of atherosclerotic disease such as CHD risk equivalents. METHODS Our study was performed in patients admitted in Internal Medicine wards and selected as a randomization list in 12 Emilia Romagna-Marche FADOI centers. 1.316 patients were registered. According to explicit inclusion/exclusion criteria, we studied overall 902 participants (50.6% men, mean of age: 71-73 years).
RESULTS According to NCEP-ATP III and IDF criteria the prevalence of MetS was 45.3% (IC 95%: 41.6-49.1) and 38.6% (IC 95%: 34.9-42.3), respectively. Patients with MetS presented a higher significant rate of ALT increase, syncope, atrial fibrillation, COPD, unstable angina, chronic kidney disease, cancer, valvular heart disease, peripheral arterial disease and carotid plaques. A strong association between IDF-MetS and congestive heart failure was observed, suggesting a role of central obesity as an independent risk factor in the elderly.
DISCUSSION World-wide populations are becoming older. Aging and MetS are two conditions that represent an important part of health-care spending. Trunkal fatness increases in old age, potentially increasing existing abdominal fatness prevalent during middle age which is already related to increased size, cardiovascular disease and the metabolic syndrome. In this study we sought to assess the high impact of MetS in Internal Medicine wards, confirming its significant relationships to many comorbidities among older adults.
CONCLUSIONS Our study emphasizes the importance of MetS and related diseases, pointing out the emerging problem of its real impact on management of these complex patients. Further research is needed to define the optimal body composition for older adults and to identify interventions that reduce morbidity and healthcare costs of MetS for this age group.