title: Identification of cardiovascular risk components in urban Chinese with metabolic syndrome and application to coronary heart disease prediction: a longitudinal study.
abstract: BACKGROUND
  Metabolic syndrome (MetS) is proposed as a predictor for cardiovascular disease (CVD). It involves the mechanisms of insulin resistance, obesity, inflammation process of atherosclerosis, and their complex relationship in the metabolic network. Therefore, more cardiovascular risk-related biomarkers within this network should be considered as components of MetS in order to improve the prediction of CVD.
  
  
  METHODS
  Factor analysis was performed in 5311 (4574 males and 737 females) Han Chinese subjects with MetS to extract CVD-related factors with specific clinical significance from 16 biomarkers tested in routine health check-up. Logistic regression model, based on an extreme case-control design with 445 coronary heart disease (CHD) patients and 890 controls, was performed to evaluate the extracted factors used to identify CHD. Then, Cox model, based on a cohort design with 1923 subjects followed up for 5 years, was conducted to validate their predictive effects. Finally, a synthetic predictor (SP) was created by weighting each factor with their risks for CHD to develop a risk matrix to predicting CHD.
  
  
  RESULTS
  Eight factors were obtained from both males and females with a similar pattern. The AUC to classify CHD under the extreme case-control suggested that SP might serve as a useful tool in identifying CHD with 0.994 (95%CI 0.984-0.998) for males and 0.998 (95%CI 0.982-1.000) for females respectively. In the cohort study, the AUC to predict CHD was 0.871 (95%CI 0.851-0.889) for males and 0.899 (95%CI 0.873-0.921) for females, highlighting that SP was a powerful predictor for CHD. The SP-based 5-year CHD risk matrix provided as convenient tool for CHD risk appraisal.
  
  
  CONCLUSIONS
  Eight factors were extracted from sixteen biomarkers in subjects with MetS and the SP adds to new insights into studies of prediction of CHD risk using data from routine health check-up.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
authors.forename: Zhenxin
authors.initials: Z
authors.lastname: Zhu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
authors.forename: Yanxun
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Health Management Center, Shandong Provincial QianFoShan Hospital, Jinan, Shandong, China.
authors.forename: Chengqi
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
authors.forename: Zhongshang
authors.initials: Z
authors.lastname: Yuan
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Health Management Center, Shandong Provincial QianFoShan Hospital, Jinan, Shandong, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Tang
authors.affiliation: Center for Health Management, Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Lin
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
authors.forename: Yongyuan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, United States of America.
authors.forename: Longjian
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
authors.forename: Fuzhong
authors.initials: F
authors.lastname: Xue
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D002681:China / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012372:ROC Curve; D012306:Risk; D012737:Sex Factors; D014505:Urban Population
chemical_list: D015415:Biomarkers