Geographic and Demographic Variation in the Prevalence of the Metabolic Syndrome in Canada Chris Ardern School of Physical and Health Education Queen’s University, Kingston, ON

Metabolic Syndrome and Mortality Lakka et al. JAMA. 2002;288: CHDCVDAll-cause * 1209 Finnish Men, years old: 11.4 years of Follow-up RR=4.2 RR=2.5 RR=2.0

Ardern et al. Obes Res. 2003;11(1):

Anand SS et al. Circ 2003;108(4): % 15.9% 14.3% Overall MetS: 25.8% N=1276 (35-75 y) 7.1% 28.8% 23.4% 28.3% 45.4% Men Women

Social and Geographic Gradients in Cardiovascular Risk Factors (CHHS) Variation in overweight and obesity (Reeder, 1997) CVD risk factor knowledge (MacDonald, 1997; Stachenko, 1992) CVD risk factor clustering (MacDonald, 1997)

Objectives 1. Describe the demographic (SES) and geographic (provincial) variation in the prevalence of the metabolic syndrome. 2.Explore the relationship between SES and metabolic syndrome within broad geographical regions (Atlantic, Central, and Western Canada).

Data Collection (clinic and home visit) –Anthropometry –Blood chemistry analyses –Blood pressure –Demographic, heart health history, and health habits/nutrition questionnaire Methods

3 or more of the following: 1.Abdominal Obesity (M: WC>102 cm; F: WC>88 cm) 2.Low HDL-C (M: <1.04 mM; F: <1.29 mM) 3.High TG (  1.69 mM) 4.High BP (  130/85 mmHg) 5.High BG (  6.1 mM; now 5.6 mM) NCEP Metabolic Syndrome

Adaptations to NCEP Definition MetS Using WC: 16.2% MetS Using BMI: 15.9% Ontario WC: 18.4% BMI: 17.4% Nova Scotia: 1. Unable to Classify Diabetes 2. MetS definition based on the presence of 3 out of 4 NCEP components

Metabolic Syndrome (shaded): N=2 966 Normal TG, HDL, BP, BMI and Non-diabetic: N=5 718 (weighted, 36.5% of sample) Most Common MetS Phenotypes Men: TG, HDL, BP (25.8% of cases) Women: TG, HDL, BMI (17.7%) 170 cases of MetS=5.7%

Results: Geographic Variation

*p<0.05 using  2 for proportions by sex, across demographic regions; †Rural/urban analysis in Atlantic region does not include NS ‡percentage above thresholds for the individual component of the metabolic syndrome definition (see methods section) a p=0.01 MenWomen Atlantic Central Western

Women: 13.2%Men: 18.2% No Data <15.0% % %  20% Age-Adjusted Prevalence of MetS 12.4% 23.8% 12.8% 22.4%

Atlantic: 21.5% Rural: 22.4% Urban: 20.0% Central: 19.3% Rural: 19.6% Urban: 19.2% Western: 16.3% Rural: 19.8% Urban: 15.0% Atlantic (PEI, NF, NB; N=2 537); Central (ON, QC N=1 628); Western (MB, SK, AB, BC; N=3 337) Men

Atlantic: 19.8% Rural: 21.2% Urban: 18.1% Central: 14.3% Rural: 12.6% Urban: 12.6% Western: 13.8% Rural: 18.7% Urban: 12.2% Atlantic (PEI, NF, NB; N=2 632); Central (ON, QC N=1 590); Western (MB, SK, AB, BC; N=3 319) Women

Results: Demographic Variation

Lowest Income Adequacy Middle Income Adequacy Highest Income Adequacy Income Adequacy

Educational Attainment  Elementary school Some secondary schooling Secondary school completed University degree completed

*p<0.05 between normal and metabolic syndrome within geographical region; percentage above threshold for the individual component of the metabolic syndrome (see methods section); †Question text: “What do you think are the major causes of heart disease or heart problems?” E=suppressed estimate due to cell count <30 observations Risk Factor Knowledge

Results: Multivariate Analysis

Bold indicates p<0.05 Men

Bold indicates p<0.05 Women

Nova Scotia was excluded from the Atlantic region for this analysis as no information on rural/urban status was available. Bold indicates p<0.05 compared to referent group. Adjusted for age, cigarette smoking, sedentary leisure time, occupational physical activity, previous heart attack or stroke, and low cardiovascular risk factor knowledge.

Clinical Relevance

MetS is useful for surveillance of CVD risk factor clustering Caveats: 1.Use of self-reported diabetes instead of fasting blood glucose means that the prevalence of MetS in this study is underestimated. 2. Lack of information on ethnicity in CHHS may result in misclassification of MetS across provinces. 3.CHHS was collected between

Conclusions 1.The distribution of the metabolic syndrome in Canada is regionally diverse. 2.The impact of educational attainment on risk of the metabolic syndrome may vary by sex and geographical region. 3.Identification of high-risk SES groups may assist in the delivery of patient-centered primary risk factor screening.

The Canadian Heart Health Surveys Follow-up Study is a New Emerging Team, funded by the Canadian Institutes for Health Research and the Heart and Stroke Foundation of Canada