Factors of the Metabolic Syndrome

Baseline Interrelationships in the First Follow-up Cohort of the HDDRISC Study (HDDRISC-1)

From the Wynn Department of Metabolic Medicine, Imperial College School of Medicine, London, UK.

Correspondence to Ian F. Godsland, PhD, Wynn Department of Metabolic Medicine, Imperial College School of Medicine, 21 Wellington Rd, London NW8 9SQ. E-mail i.godsland{at}ic.ac.uk

Abstract—Syndromes of risk factor disturbance may contribute to the development of coronary heart disease and non–insulin-dependent diabetes mellitus, but their definition and quantification remain problematic. Using factor analysis, constellations of risk factor variables that could indicate distinct syndromes of metabolic disturbance were explored in the baseline data of the first follow-up cohort of 742 men from the Heart Disease and Diabetes Risk Indicators in a Screened Cohort (HDDRISC) study. The primary analysis considered 16 intercorrelated variables measured in more than 90% of cohort participants. A missing-values estimation routine was used to ensure inclusion of all participants in the analysis. Subanalyses were undertaken, including a repeat of the primary analysis on the 522 individuals who had received measurement of HDL cholesterol, an oblique rather than orthogonal factor rotation procedure performed on primary and HDL subset analyses, a repeat of these two primary and HDL subset analyses using only those participants with complete measurements, and a repeat of these six analyses including only the seven variables conventionally associated with the metabolic syndrome. The principal factor that emerged in all analyses undertaken comprised oral glucose tolerance test insulin and glucose response, serum uric acid, and body mass index. Fasting serum triglyceride concentration was included in this factor in 11 of the 12 analyses undertaken, fasting plasma insulin in 8, fasting plasma glucose in 5, and mean arterial pressure in 3. HDL cholesterol factored in isolation from insulin in all analyses undertaken. These findings provide strong support for a core metabolic cluster, which is unlikely to include blood pressure and does not include HDL. The factor scores relating to this cluster will provide a means of assessing its quantitative importance in prospective analysis of the development of CHD and diabetes in this cohort.

Key Words: factor analysis • metabolic syndrome • cohort study • insulin • high density lipoprotein

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