title: Waist circumference and metabolic risk factors have separate and additive effects on the risk of future Type 2 diabetes in patients with vascular diseases. A cohort study.
abstract: OBJECTIVE
  To assess the effect of various measures of adiposity and of metabolic risk factors, both separately and in combination, on the risk of future Type 2 diabetes in patients with manifest vascular diseases.
  
  
  METHODS
  This was a prospective cohort study in 2924 patients (mean age 59 ± 12 years) with manifest atherosclerosis. Metabolic risk factors were defined according to National Cholesterol Education Program criteria for the metabolic syndrome. Incidence of Type 2 diabetes was assessed by questionnaire and subsequent verification.
  
  
  RESULTS
  During a median follow-up of 4.9 years (range 3.0-7.6 years) there were 178 cases (6.1%) of incident Type 2 diabetes. An increase with 1 sd waist circumference showed a strong association with incident Type 2 diabetes in both men (hazard ratio 2.45, 95% CI 1.97-3.04) and women (hazard ratio 1.77, 95% CI 1.38-2.26). Compared with patients with normal (i.e. below the National Cholesterol Education Program criteria for abdominal adiposity) waist circumference and < 3 metabolic risk factors, both patients with normal waist circumference and ≥ 3 metabolic risk factors and patients with high (i.e. above the National Cholesterol Education Program criteria for abdominal adiposity) waist circumference and < 3 metabolic risk factors had an increased risk of Type 2 diabetes (hazard ratio 2.44, 95% CI 1.37-4.36 and hazard ratio 3.61, 95% CI 2.23-5.85, respectively). Patients with both high waist circumference and ≥ 3 metabolic risk factors had the highest risk of developing Type 2 diabetes (hazard ratio 10.76, 95% CI 6.95-16.64).
  
  
  CONCLUSIONS
  In patients with manifest atherosclerosis, both presence of ≥ 3 metabolic risk factors and presence of a high waist circumference alone are associated with increased risk for developing Type 2 diabetes. The combined presence of ≥ 3 metabolic risk factors and high waist circumference, which is present in 15% of patients, is associated with a 10-fold increased risk of future Type 2 diabetes. To identify patients with manifest atherosclerosis at the highest risk of developing Type 2 diabetes, fat distribution in combination with metabolic risk factors should be considered.
authors.affiliation: Department of Vascular Medicine, University Medical Centre Utrecht, the Netherlands. a.m.j.wassink@umcutrecht.nl
authors.forename: A M J
authors.initials: AM
authors.lastname: Wassink
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: T W
authors.initials: TW
authors.lastname: van Haeften
authors.forename: W
authors.initials: W
authors.lastname: Spiering
authors.forename: S S
authors.initials: SS
authors.lastname: Soedamah-Muthu
authors.forename: F L J
authors.initials: FL
authors.lastname: Visseren
mesh_terms: D050154:Adiposity / Q000502:physiology*; D050197:Atherosclerosis / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055105:Waist Circumference / Q000502:physiology*