The Prevalence of Cardiovascular Risk Factors in Patients with and Without Metabolic Syndrome in Diabetes Mellitus: A Study Based on Rafsanjan Cohort Study

The Prevalence of Cardiovascular Risk Factors in Patients with and Without Metabolic Syndrome in Diabetes Mellitus: A Study Based on Rafsanjan Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Prevalence of Cardiovascular Risk Factors in Patients with and Without Metabolic Syndrome in Diabetes Mellitus: A Study Based on Rafsanjan Cohort Study Zahra Kamiab, Mitra Abbasifard, Ali Esmaeili Nadimi, Hasan Alinejad, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1186156/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Cardiovascular disease (CVD) is the leading causes of death and disability in diabetes. This study aimed to determine the prevalence of cardiovascular risk factors in people with and without metabolic syndrome (MtS) in diabetes mellitus (DM). Methods This cross-sectional study was part of Rafsanjan Cohort Study (RCS).as part of the comprehensive PERSIAN (Prospective Epidemiological Research Studies in IrAN) on adults with and without MtS in DM. CVD risk factors, including gender, age, blood pressure, dyslipidemia, smoking, alcohol consumption, fasting blood sugar, creatinine, blood urea, waist circumference, body mass index, family history, physical inactivity, fruit and vegetable consumption were collected in the PERSIAN Cohort Questionnaire. The data were analyzed by SPSS software version 22. Results The prevalence of MtS in 1933 participants was estimated to be 80% (95% confidence interval 81.8% -78.1%). In the logistic regression model, smoking, alcohol consumption, triglyceride to HDL (High Density Lipoprotein) ratio, abdominal obesity, and hypertension were identified as the factors associated with MtS. Conclusions Our results show that Based on our study, the prevalence of cardiovascular risk factors in DM was high. Reducing smoking and alcohol consumption and controlling hypertension, hyperlipidemia, and overweight are the suggested solutions in this field. Cardiovascular Risk Factors Syndrome Metabolic Diabetes Mellitus Prospective Epidemiological Research Studies in IrAN (PERSIAN) Figures Figure 1 Introduction The International Diabetes Federation (IDF) estimates that diabetes accounts for 8.8% of the world's population and is projected to increase to 642 million by 2040. The prevalence of diabetes mellitus (DM) is constantly increasing over time ( 1 ). In Iran, the prevalence of DM in adults aged 25 to 70 years is reported to be 11.9%. It is estimated that by 2030, about 9.2 million Iranians are likely to have DM. Cardiovascular disease (CVD) is one of the leading causes of death and disability in people with DM ( 2 ). The risk of CVD is constantly increasing by increasing fasting plasma glucose levels, even before reaching a sufficient level to diagnose DM ( 3 ). DM reduces life expectancy by up to 10 years and more than 50% of patients die of a cardiovascular event ( 4 ). People with DM are more likely to be affected by CVD than non-diabetic people ( 2 , 5 ). Diabetic patients had a 10% higher risk of CVD, a 53% higher risk of MI, a 58% higher risk of stroke, and a 12% higher risk of heart failure than the non-diabetic population. Thus, DM is a major risk factor for CVD and its consequences ( 6 ). The literature review shows that in New York, patients with DM are almost three times more likely to develop heart disease than their non-diabetic counterparts ( 7 ). This ratio has been studied in some areas in Iran. For instance, the risk of CVD in DM patients in a study in Yazd was about 2-4 times ( 8 ). and in another study in Ahvaz was 2-8 times that of the general population ( 9 ). The risk of CVD in DM follows a slope, and the severity of this slope depends on a combination of multiple risk factors ( 10 ). Most of these additional risks of CVD in DM are associated with an increased prevalence of known risk factors, such as hypertension, dyslipidemia, and obesity ( 11 ). Over the last decade, studies have shown that treating known risk factors for patients with DM is extremely important in reducing the risks of CVD ( 12 ). Poor control of most cardiovascular risk factors has been observed in the diabetic population. However, the additional risks of CVD in DM patients cannot be attributed solely to the higher prevalence of known risk factors ( 13 ). Therefore, other risk factors may be important in people with DM ( 14 ). A set of interrelated risk factors characterize metabolic syndrome (MtS), including hypertension, hyperglycemia, abdominal obesity, and dyslipidemia ( 15 ). The disease is associated with an increased risk of cardio-vascular events, DM, and deaths ( 16 ). NCEP-ATPIII (the National Cholesterol Education Program-Adult Treatment Panel) Criteria, IDF, and WHO (World Health Organization) definitions reported that the prevalence of MtS in DM were 45.8%, 57.7%, and 28%, respectively in India ( 17 ). According to a study conducted in Nepal, the total age adjusted prevalence rates of MtS according to Harmonized, NCEP ATP III, WHO and IDF definitions were 80.3%, 73.9%, 69.9%, and 66.8%, respectively. The lowest agreement was observed between WHO and IDF definitions and the highest overall agreement was between Harmonized and NCEP ATP III definitions ( 18 ). The extent of these risk factors has been widely examined in studies; since finding the correlation between DM risk factors and CVD can be effective in preventing the incidence of morbidity and mortality in patients ( 19 ). Endocrinologists and cardiologists suggest that more efforts should be made to improve the risk factors for heart disease in diabetic patients due to their higher risk of heart attack and the higher mortality rate ( 20 ). Therefore, this study aimed to determine the prevalence of cardiovascular risk factors in people with and without MtS in DM in Rafsanjan adult cohort study. Materials And Methods This cross-sectional study was performed based on Rafsanjan Cohort Study (RCS) ( 21 ) as part of the comprehensive PERSIAN (Prospective Epidemiological Research Studies in IrAN) ( 22 ). The cohort study included 10,000 people aged 35-70 years who were randomly invited to the study from urban and rural areas covered by the health centers of this city. The inclusion criteria of cohort study were 1- Iranian citizenship 2- having an age range of 35-70 years, 3- living at least 9 months a year in the studied area in Rafsanjan city. The exclusion criteria included lack of understanding the Persian language and the existence of severe physical and mental disorders. PERSIAN Cohort standard questionnaires consisting of 482 questions in 3 major sections of general, medical, and nutrition were asked from the participants by a trained interviewer. The validity and reliability of all questionnaires were confirmed. The face to face interview was conducted by trained interviewers and the participants’ answers were collected electronically and confidentially after obtaining their consent ( 21 ). In this study, all the DM patients in the cohort population were included based on the past medical history and their self-expression. The presence of MtS in each individual was assessed and they divided to two groups with and without MtS. The diagnostic criteria for this syndrome were defined in such a way that the patient met at least three of the five MtS criteria at the same time as described by American Heart Association. ( 23 ), including: (a) central obesity determined by waist circumference equal to or greater than 88 cm (35 inches) in women and equal to or greater than 102 cm (40 inches) in men; (b) fasting serum triglyceride level equal to or greater than 150 mg/dL or on drug therapy for hypertriglyceridemia (e.g., fibrates, nicotinic acid); (c) High Density Lipoprotein (HDL) level less than 50 mg/dL in women and less than 40 mg/dL in men or on drug therapy for low high-density lipoprotein level (fibrates, nicotinic acid); (d) elevated diastolic blood pressure equal to or greater than 85 or elevated systolic blood pressure equal to or greater than 130 or on drug therapy for hypertension; (e) elevated fasting glucose level equal to or greater than 100 mg/dL or on drug therapy for hyperglycemia/diabetes. Demographic and clinical characteristics of individuals were extracted from the cohort center database, including gender, age, education level, residence, race, hypertension, dyslipidemia, smoking, alcohol consumption, systolic and diastolic blood pressure, heart rate, fasting blood sugar, triglycerides, LDL (low-density lipoprotein), HDL (High Density Lipoprotein), creatinine, blood urea nitrogen (BUN), alkaline phosphatase (ALP), waist circumference, body mass index (BMI= weight (kg)/height2 (m)), height and weight, family history of cardiovascular disease, physical inactivity, and insufficient consumption of fruits and vegetables. In this study, the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) was less than 2, 2 to 3.8, and more than 3.8, indicating favorable, moderate risk, and high risk of insulin resistance, respectively ( 24 ). The participants were classified in three different groups in terms of physical activity based on the Scoring the International Physical Activity Questionnaire (IPAQ) recommendations for scoring protocol. The groups included low active (<600 MET–minutes/week); moderate active (≥600 MET–minutes/week) and high active (≥3000 MET–minutes/week) ( 25 ), considering the MET–min/wk of the sum of walking, moderate-intensity physical activities, and vigorous-intensity physical activities. In terms of fruit and vegetable consumption, the subjects were divided into two groups according to the WHO recommendation, including high consumption (more than 400 grams of fruits and vegetables per day) and low consumption (less than 400 grams of fruits and vegetables per day) ( 26 ). BMI categories were defined as follows: normal, BMI 20 to 24.9; overweight, BMI 25 to 29.9; obese I, BMI 30 to 34.9; obese II, BMI 35 to 39.9; morbid obesity, BMI ≥40( 27 ). Statistical analysis: All the data were entered in SPSS software version 22 and for descriptive analysis of data, mean and standard deviation or frequency and percentage were used. In order to investigate the relationships due to abnormality, Mann-Whitney U test and Chi-square test (for classification variables) were used. Multiple logistic regression model was used to determine the factors associated with MtS. The significance level (P value) was considered less than 0.05. Results Out of 1933 patients with DM in this study, 1213 (62.8%) were female and 720 (37.2%) were male. The mean age of the participants was 55.92 ± 8.17 years. The prevalence of MtS in this study was estimated to be 80% with a 95% confidence interval 81.8% -78.1%, so that 1546 patients had at least three of the 5 diagnostic factors of MtS. The prevalence of MtS was significantly higher in women (66.9%) compared to men (33.1%) (P-value<0.001). Moreover, the mean age of the subjects in the MtS group was significantly higher than the group without MtS (56.31±7.98 years compared to 54.37±8.74 years, P-value <0.001). The frequency distribution comparison of demographic and clinical characteristics of the patients in the two groups with and without MtS is given in Table 1 and Figure 1 . As can be seen, education level, marital status, smoking, alcohol consumption, history of hypertension, history of ischemic heart disease, family history of stroke, and consumption of fruits and vegetables were significantly different between the two groups (P-value <0.05). All the participants were low active and most of the subjects (84.7%) were in the group of low consumption of fruits and vegetables. Table 1 Comparison of demographic and clinical characteristics in the two groups with and without MtS in type 2 diabetes mellitus Variables Total (1933=n) Without metabolic syndrome (387=n) With metabolic syndrome (1546=n) P-value Age (62-50) 57 (61-47) 5/55 (63-51) 57 001/0> Gender Male (2/37) 720 (54) 209 (1/33) 511 001/0> Female (8/62) 1213 (46) 178 (9/66) 1035 Marital status Single (2/11) 217 (9/5) 23 (5/12) 194 001/0> Married (8/88) 1716 (1/94) 364 (5/87) 1352 Education level Illiterate (3/18) 353 (4/12) 48 (7/19) 305 001/0> Diploma and lower (0/71) 1373 (7/67) 262 (9/71) 1111 Academic degree (7/10) 207 (9/19) 77 (4/8) 130 Family history of ischemic heart disease Yes (3/14) 276 (3/16) 63 (8/13) 213 208/0 No (7/85) 1657 (7/83) 324 (2/86) 1333 family history of heart attack Yes (5/11) 223 (6/11) 45 (5/11) 178 950/0 No (5/88) 1710 (4/88) 342 (5/88) 1368 Family history of high blood pressure Yes (7/19) 380 (2/21) 82 (3/19) 298 397/0 No (3/80) 1553 (8/78) 305 (7/80) 1248 Family history of diabetes mellitus Yes (0/22) 426 (5/24) 95 (4/21) 331 183/0 No (0/78) 1507 (5/75) 292 (6/78) 1215 family history of stroke Yes (3/8) 161 (1/11) 43 (6/7) 118 027/0 No (7/91) 1772 (9/88) 344 (4/92) 1428 consumption of fruits and vegetables Low (7/84) 888 (2/90) 194 (2/83) 694 011/0 Normal (3/15) 161 (8/9) 21 (8/16) 140 Medium (first quarter-third quarter) for age and frequency (%) is reported for qualitative variables. In order to compare age in the two groups, Mann-Whitney test and to perform other comparisons Chi-square test were used. The prevalence of risk factors in the group without MtS included 33.9% abdominal obesity (95% confidence interval: 29.18-38.62), 19.7% obesity (95% confidence interval: 17.72-21.68), 27.1% hypertriglyceridemia (95% confidence interval: 22.67-31.53), 15.8% hypertension (95% confidence interval: 12.17-19.43), 15.8% smoking (95% confidence interval: 12.17- 19.43), 12.7% the history of ischemic heart disease (95% confidence interval: 9.39-16.01), 5.9% alcohol consumption (95% confidence interval: 3.55-8.25), and low HDL 1.3% (95% confidence interval: 0.18-2.42), respectively. The prevalence of risk factors in the MtS group was reported 80.5% hypertriglyceridemia (95% confidence interval: 78.54-82.46), 75.9% abdominal obesity (95% confidence interval: 73.76-78.04), 64% hypertension (95% confidence interval: 61.66-66.39), 48%low HDL (95% confidence interval: 45.51-50.49), 43.8% obesity (95% confidence interval: 41.33-46.27), 22.3% smoking (95% confidence interval: 20.22-24.38), 19% history of ischemic heart disease in (95% confidence interval: 18.80-19.20), and 9.4% alcohol consumption (95% confidence interval: 7.95-10.85), respectively. Figure 1 reveals that the prevalence of the above factors in the two groups were statistically significant (P-value <0.05). Given the studied subjects were all patients with DM, all of them had at least one of the 5 factors of MtS. Therefore, the frequency distribution of the number of MtS factors included 4.4% only one factor (n=85), 15.6% two factors (n=302), 37.1% three factors (n=716), 31.1% four factors (n=601), and 11.7% five factors (n=226). Given the abnormal distribution of anthropometric indices and biochemical and laboratory indices, the Mann-Whitney non-parametric test was used for comparing the two groups, which is shown in Table 2 . The median of BMI, systolic blood pressure, diastolic blood pressure, heart rate, triglyceride, ALP, and TG to HDL ratio were significantly higher in the MtS group and HDL was significantly lower than the group without MtS. Table 2 Comparison of the median of anthropometric and laboratory indices of patients with type 2 diabetes mellitus in the two groups with and without MtS Variables Total (1933=n) Without metabolic syndrome (387=n) With metabolic syndrome (1546=n) P-value Waist circumference (6/106-6/92) 5/99 (53/99-08/87) 05/94 (9/107-5/94) 2/101 001/0> BMI (93/31-84/25) 66/28 (01/29-12/24) 45/26 (49/32-40/26) 30/29 001/0> Systolic blood pressure (125-100) 115 (5/118-100) 108 (125-100) 115 001/0> Diastolic blood pressure (80-65) 70 (80-65)70 (80-65) 75 001/0> Heart rate (82-70) 76 (80-68) 74 (83-70) 76 001/0 Fasting blood sugar (188-114) 144 (25/182-111) 143 (189-115) 145 3/0 Triglyceride (229-121) 165 (160-100) 126 (240-5/132) 179 001/0> Cholesterol (223-167) 193 (218-164) 5/191 (225-167) 194 098/0 HDL (64-49) 56 (66-52) 59 (63-48) 56 001/0> LDL (124-78) 100 (125-80) 99 (124-78) 100 430/0 Creatinine (2/1-9/0) 1 (2/1-9/0) 1 (2/1-9/0) 1 143/0 BUN (17-12) 14 (17-12) 14 (17-12) 14 261/0 ALP (277-192) 232 (259-75/186) 219 (281-194) 235 001/0> TG to HDL ratio (29/4-07/2) 96/2 (84/2-60/1) 15/2 (49/4-25/2) 22/3 001/0> Median (first quarter-third quarter) is reported for the variables. Mann-Whitney test was used to compare the two groups. Low-Density Lipoproteins (LDL), High-Density Lipoproteins (HDL), Alkaline Phosphatase (ALP), Blood Urea Nitrogen (BUN) In order to investigate the relationship between demographic characteristics, disease history, anthropometric indices, and biochemical factors with MtS, univariate logistic regression was performed for all the studied variables. Then, significant variables at the level of 0.1 were entered into the multiple logistic regression model using Backward LR method. According to the results of logistic regression model (Table 3 ), smoking, alcohol consumption, TG to HDL ratio, abdominal obesity, and hypertension were identified as factors associated with MtS in this study. So the risk of MtS was increased by smoking 5.60% (95% confidence interval: 3.67-8.55), alcohol consumption 4.1% (95% confidence interval: 2.32-7.23), TG to HDL ratio 1.42% (95% confidence interval: 1.30-1.55), abdominal obesity 13.73% (95% confidence interval: 9.77-19.29), and hypertension 13.54% (95% confidence interval: 9.55-19.19), respectively. Considering that hypertension and abdominal obesity are the 5 causes of MtS, it is associated with a high risk of developing MtS. Table 3 Multivariate logistic regression results Variables OR (95% CI) P-value TG to HDL ratio (55/1-30/1) 42/1 001/0> Abdominal obesity No ref -- 001/0> Yes (29/19-77/9) 73/13 Smoking No ref -- 001/0> Yes (55/8-67/3) 60/5 Alcohol consumption No ref -- 001/0> Yes (23/7-32/2) 098/4 Hypertension No ref -- 011/0 Yes (19/19-55/9) 54/13 Multiple logistic regression model using Backward LR method. High-Density Lipoproteins (HDL), Triglyceride (TG) Discussion Cardiovascular diseases are the leading cause of death and disability in diabetic patients ( 28 ). high blood pressure, hyperlipidemia, MtS, and smoking are important risk factors for cardiovascular disease ( 29 ), and the association of these factors with cardiovascular disease is completely identified ( 30 , 31 ). The results of the present study revealed that in patients with DM smoking, alcohol consumption, triglyceride to HDL ratio, abdominal obesity, and hypertension were identified as the factors associated with MtS. MtS is a set of multiple risk factors for atherosclerotic cardiovascular disease and DM ( 32 ). MtS is strongly associated with DM. In this type of diabetes, there is insulin resistance with secondary hyperinsulinemia and it is often associated with high blood pressure, dyslipidemia, atherosclerosis, and most importantly obesity, especially central obesity. Etiology of MtS consists of separate components of the MtS (such as hypertension, DM, dyslipidemia) causing complex conditions ( 33 ). The prevalence of MtS in this study was estimated to be 80%. Its prevalence according to IDF criteria in people with Type 2 Diabetes Mellitus in the study by Moreira et al. was reported to be 74.3% *. It was also 69.5% in the study by AlSaraj et al. ( 34 ). Different prevalence of MtS in populations, in addition to methodological differences, could be due to various nutritional, epidemiological, and demographic transitions ( 35 ), as well as ethnic ( 36 ), social, and environmental ( 37 ) disparities. In this study, the prevalence of hypertension in the group without MtS was 15.8% and in the MtS group was 64%. However, the prevalence of hypertension with diabetes varied in different ethnic, racial, and social groups ( 33 ). In previous studies, the prevalence of hypertension in patients with diabetes, covering more than 30,000 people in different areas, 70% of diabetic patients have been reported to have hypertension ( 38 ). This rate is more consistent with the blood pressure statistics in diabetic patients with MtS in this study. In the current study, smoking, alcohol consumption, and TG to HDL ratio were also identified as factors associated with MtS in patients with DM. These results were confirmed by Lindsay et al. and Mottillo et al. ( 39 , 40 ). Slagter et al. reported that alcohol and cigarette consumption increase the risk of MtS and some of its components in a dose-dependent manner ( 41 ). It has been found that high levels of LDL, high blood pressure, and smoking are the most important risk factors for cardiovascular disease in DM and low HDL cholesterol, insulin resistance, hyperglycemia, and inflammation are also predictors of cardiovascular complications ( 42 ). Previous studies have reported that obesity, especially central obesity, is the main underlying cause of MtS, causing a genetic predisposition for other risk factors, such as dyslipidemia and hypertension ( 43 ). In the present study, the prevalence of abdominal obesity in diabetic patients without MtS was 33.9%, which reached 75.9% in DM patients with MtS. In the study by Cheng et al., abdominal obesity was reported in 91.6% of people with DM ( 44 ), which is higher than the results of the present study. Central obesity is a major risk factor for MtS and diabetes ( 45 ), also increases the risk of dyslipidemia and coronary artery disease ( 46 ). Lack of access to complete information in the files and the defects in the files were among the most important limitations of this study, which were controlled as much as possible by removing incomplete files and replacement. Conclusion The high prevalence of MtS in patients with DM in Rafsanjan adult cohort study indicates the importance of this issue. Therefore, high risk patients can be identified using MtS screening in primary health centers, and they can benefit from timely multifactorial interventions. Reducing smoking and alcohol consumption, and controlling hypertension, hyperlipidemia, and overweight are some of the suggested solutions in this regard. Abbreviations CVD, Cardiovascular disease; MtS, metabolic syndrome; DM, diabetes mellitus; RCS, Rafsanjan Cohort Study; PERSIAN, Prospective Epidemiological Research Studies in IrAN; IDF, International Diabetes Federation; NCEP-ATPIII, the National Cholesterol Education Program-Adult Treatment Panel; WHO, World Health Organization; LDL, low-density lipoprotein; HDL, High Density Lipoprotein; BUN, blood urea nitrogen; ALP, alkaline phosphatase; BMI, body mass index. Declarations Ethics approval and consent to participate Study was carried out in accordance with ethical guidelines of prospective epidemiological studies of the population in Iran (PERSIAN cohort) and ethical Committee for Rafsanjan University of Medical Sciences, Rafsanjan, Iran (IR.RUMS.REC.1399.050). All patients provided written informed consent. Our present medical research was conducted according to the principles expressed in the 1975 Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to PERSIAN cohort policy on availability of health care registers, but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The Iranian Ministry of Health and Medical Education has contributed to the funding used in the PERSIAN Cohort through Grant No. 700/534. This study has also been supported by the Vice Chancellery for Research & Technology of Rafsanjan University of Medical Sciences. Authors’ contributions ZK and GhB initiated the study and were responsible for elaborating the concept of it, and critically revised the manuscript. ZK and MA contributed to the extraction, analysis and interpretation of the data. ZK, GhB, HAand AEN contributed to the quality assessment of data, data analysis and interpretation, and drafted the manuscript. All authors read and approved the final manuscript. Acknowledgments The authors would like to thank the Clinical Research Development Unit for its support and collaboration in Ali-Ibn Abi-Talib hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 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Nonalcoholic fatty liver disease and vascular disease: state-of-the-art. World Journal of Gastroenterology: WJG. 2014;20(37):13306. Asgeirsdottir TL, Olafsdottir T, Ragnarsdottir DO. Business cycles, hypertension and cardiovascular disease: evidence from the Icelandic economic collapse. Blood Pressure. 2014;23(4):213–21. Hajar R. Risk factors for coronary artery disease: historical perspectives. Heart views: the official journal of the Gulf Heart Association. 2017;18(3):109. Grundy SM. Metabolic syndrome update. Trends in cardiovascular medicine. 2016;26(4):364–73. Rashid JR, Leath BA, Truman BI, Atkinson DD, Gary LC, Manian N. Translating comparative effectiveness research into practice: effects of interventions on lifestyle, medication adherence, and self-care for type 2 diabetes, hypertension, and obesity among black, Hispanic, and Asian residents of Chicago and Houston, 2010 to 2013. Journal of Public Health Management and Practice. 2017;23(5):468–76. AlSaraj F, McDermott J, Cawood T, McAteer S, Ali M, Tormey W, et al. Prevalence of the metabolic syndrome in patients with diabetes mellitus. Irish journal of medical science. 2009;178(3):309–13. Amuna P, Zotor FB. Epidemiological and nutrition transition in developing countries: impact on human health and development: The epidemiological and nutrition transition in developing countries: evolving trends and their impact in public health and human development. Proceedings of the Nutrition Society. 2008;67(1):82-90. Salsberry PJ, Corwin E, Reagan PB. A complex web of risks for metabolic syndrome: race/ethnicity, economics, and gender. American journal of preventive medicine. 2007;33(2):114–20. Chow CK, Lock K, Teo K, Subramanian S, McKee M, Yusuf S. Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review. International journal of epidemiology. 2009;38(6):1580–94. Association AD. Erratum. Comprehensive Medical Evaluation and Assessment of Comorbidities. Sec. 3. In Standards of Medical Care in Diabetes—2017. Diabetes Care 2017; 40 (Suppl. 1); S25–S32. Diabetes Care. 2017;40(7):985. Lindsay RS, Howard BV. Cardiovascular risk associated with the metabolic syndrome. Current diabetes reports. 2004;4(1):63–8. Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. Journal of the American College of Cardiology. 2010;56(14):1113–32. Slagter SN, van Vliet-Ostaptchouk JV, Vonk JM, Boezen HM, Dullaart RP, Kobold ACM, et al. Combined effects of smoking and alcohol on metabolic syndrome: the LifeLines cohort study. PloS one. 2014;9(4):e96406. Laakso M, Kuusisto J. Insulin resistance and hyperglycaemia in cardiovascular disease development. Nature Reviews Endocrinology. 2014;10(5):293–302. Zafar U, Khaliq S, Ahmad HU, Manzoor S, Lone KP. Metabolic syndrome: an update on diagnostic criteria, pathogenesis, and genetic links. Hormones. 2018;17(3):299–313. Cheng Y, Zhang H, Chen R, Yang F, Li W, Chen L, et al. Cardiometabolic risk profiles associated with chronic complications in overweight and obese type 2 diabetes patients in South China. PloS one. 2014;9(7):e101289. Tyrovolas S, Koyanagi A, Garin N, Olaya B, Ayuso-Mateos JL, Miret M, et al. Diabetes mellitus and its association with central obesity and disability among older adults: a global perspective. Experimental Gerontology. 2015;64:70–7. Onat A, Avcı GŞ, Barlan M, Uyarel H, Uzunlar B, Sansoy V. Measures of abdominal obesity assessed for visceral adiposity and relation to coronary risk. International journal of obesity. 2004;28(8):1018–25. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1186156","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":77403567,"identity":"55c664e3-2a86-4f38-8e5d-5a768d10b402","order_by":0,"name":"Zahra Kamiab","email":"","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Kamiab","suffix":""},{"id":77403568,"identity":"7a530ace-55ff-4815-98d6-fbaf347fe303","order_by":1,"name":"Mitra Abbasifard","email":"","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mitra","middleName":"","lastName":"Abbasifard","suffix":""},{"id":77403569,"identity":"4bf2a882-1849-439e-a9db-f281dbf47d92","order_by":2,"name":"Ali Esmaeili Nadimi","email":"","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"Esmaeili","lastName":"Nadimi","suffix":""},{"id":77403570,"identity":"2ee43f15-2c3e-4c0c-812b-1d095e1fd7de","order_by":3,"name":"Hasan Alinejad","email":"","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hasan","middleName":"","lastName":"Alinejad","suffix":""},{"id":77403571,"identity":"e467eda2-4fd2-48c4-9fde-dd7e4c537c12","order_by":4,"name":"Gholamreza Bazmandegan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYBACAx4eBmYwi70BxLUgWosBAwPPARBXghQtEgkgPhFazHnOHvtc8OePnPnM51c3/CiQYOBv707Aq8Wyty959sw2A2OZ2zllN3uADpM4c3YDfoed5zFm5m0wSJwhnZN2gweoxUAilwgtPH8M6mdInkm7+YcoLWd7gFrYDBIkJNiP3SbKFsueM8bMM9uMDWfw5LDdljGQ4CHoF3OeHGPmgj9y8hLsx5/dfPPHRo6/vRe/FiTAYwAmiVUOAuwPSFE9CkbBKBgFIwgAAGioQGOYYUvrAAAAAElFTkSuQmCC","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Gholamreza","middleName":"","lastName":"Bazmandegan","suffix":""}],"badges":[],"createdAt":"2021-12-19 17:59:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1186156/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1186156/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":17503325,"identity":"7a0f3598-4951-47e7-9518-becdfe7441fb","added_by":"auto","created_at":"2022-01-20 16:04:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54893,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence (95% confidence interval) of risk factors in the two groups with and without MtS\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-1186156/v1/c125ed7d58bbe65b9160dda0.png"},{"id":18426871,"identity":"1a2d7477-59dc-4d36-b2a5-b93096d9ba82","added_by":"auto","created_at":"2022-02-21 09:59:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":397543,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1186156/v1/4d50606d-fe4e-41c2-8497-fdd793435273.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Prevalence of Cardiovascular Risk Factors in Patients with and Without Metabolic Syndrome in Diabetes Mellitus: A Study Based on Rafsanjan Cohort Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe International Diabetes Federation (IDF) estimates that diabetes accounts for 8.8% of the world's population and is projected to increase to 642 million by 2040. The prevalence of diabetes mellitus (DM) is constantly increasing over time (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Iran, the prevalence of DM in adults aged 25 to 70 years is reported to be 11.9%. It is estimated that by 2030, about 9.2 million Iranians are likely to have DM. Cardiovascular disease (CVD) is one of the leading causes of death and disability in people with DM (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The risk of CVD is constantly increasing by increasing fasting plasma glucose levels, even before reaching a sufficient level to diagnose DM (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). DM reduces life expectancy by up to 10 years and more than 50% of patients die of a cardiovascular event (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). People with DM are more likely to be affected by CVD than non-diabetic people (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDiabetic patients had a 10% higher risk of CVD, a 53% higher risk of MI, a 58% higher risk of stroke, and a 12% higher risk of heart failure than the non-diabetic population. Thus, DM is a major risk factor for CVD and its consequences (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The literature review shows that in New York, patients with DM are almost three times more likely to develop heart disease than their non-diabetic counterparts (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This ratio has been studied in some areas in Iran. For instance, the risk of CVD in DM patients in a study in Yazd was about 2-4 times (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). and in another study in Ahvaz was 2-8 times that of the general population (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe risk of CVD in DM follows a slope, and the severity of this slope depends on a combination of multiple risk factors (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Most of these additional risks of CVD in DM are associated with an increased prevalence of known risk factors, such as hypertension, dyslipidemia, and obesity (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Over the last decade, studies have shown that treating known risk factors for patients with DM is extremely important in reducing the risks of CVD (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Poor control of most cardiovascular risk factors has been observed in the diabetic population. However, the additional risks of CVD in DM patients cannot be attributed solely to the higher prevalence of known risk factors (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Therefore, other risk factors may be important in people with DM (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). A set of interrelated risk factors characterize metabolic syndrome (MtS), including hypertension, hyperglycemia, abdominal obesity, and dyslipidemia (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The disease is associated with an increased risk of cardio-vascular events, DM, and deaths (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNCEP-ATPIII (the National Cholesterol Education Program-Adult Treatment Panel) Criteria, IDF, and WHO (World Health Organization) definitions reported that the prevalence of MtS in DM were 45.8%, 57.7%, and 28%, respectively in India (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). According to a study conducted in Nepal, the total age adjusted prevalence rates of MtS according to Harmonized, NCEP ATP III, WHO and IDF definitions were 80.3%, 73.9%, 69.9%, and 66.8%, respectively. The lowest agreement was observed between WHO and IDF definitions and the highest overall agreement was between Harmonized and NCEP ATP III definitions (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe extent of these risk factors has been widely examined in studies; since finding the correlation between DM risk factors and CVD can be effective in preventing the incidence of morbidity and mortality in patients (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Endocrinologists and cardiologists suggest that more efforts should be made to improve the risk factors for heart disease in diabetic patients due to their higher risk of heart attack and the higher mortality rate (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Therefore, this study aimed to determine the prevalence of cardiovascular risk factors in people with and without MtS in DM in Rafsanjan adult cohort study.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003eThis cross-sectional study was performed based on Rafsanjan Cohort Study (RCS) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) as part of the comprehensive PERSIAN (Prospective Epidemiological Research Studies in IrAN) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The cohort study included 10,000 people aged 35-70 years who were randomly invited to the study from urban and rural areas covered by the health centers of this city. The inclusion criteria of cohort study were 1- Iranian citizenship 2- having an age range of 35-70 years, 3- living at least 9 months a year in the studied area in Rafsanjan city. The exclusion criteria included lack of understanding the Persian language and the existence of severe physical and mental disorders. PERSIAN Cohort standard questionnaires consisting of 482 questions in 3 major sections of general, medical, and nutrition were asked from the participants by a trained interviewer. The validity and reliability of all questionnaires were confirmed. The face to face interview was conducted by trained interviewers and the participants\u0026rsquo; answers were collected electronically and confidentially after obtaining their consent (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, all the DM patients in the cohort population were included based on the past medical history and their self-expression. The presence of MtS in each individual was assessed and they divided to two groups with and without MtS. The diagnostic criteria for this syndrome were defined in such a way that the patient met at least three of the five MtS criteria at the same time as described by American Heart Association. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), including: (a) central obesity determined by waist circumference equal to or greater than 88 cm (35 inches) in women and equal to or greater than 102 cm (40 inches) in men; (b) fasting serum triglyceride level equal to or greater than 150 mg/dL or on drug therapy for hypertriglyceridemia (e.g., fibrates, nicotinic acid); (c) High Density Lipoprotein (HDL) level less than 50 mg/dL in women and less than 40 mg/dL in men or on drug therapy for low high-density lipoprotein level (fibrates, nicotinic acid); (d) elevated diastolic blood pressure equal to or greater than 85 or elevated systolic blood pressure equal to or greater than 130 or on drug therapy for hypertension; (e) elevated fasting glucose level equal to or greater than 100 mg/dL or on drug therapy for hyperglycemia/diabetes.\u003c/p\u003e \u003cp\u003eDemographic and clinical characteristics of individuals were extracted from the cohort center database, including gender, age, education level, residence, race, hypertension, dyslipidemia, smoking, alcohol consumption, systolic and diastolic blood pressure, heart rate, fasting blood sugar, triglycerides, LDL (low-density lipoprotein), HDL (High Density Lipoprotein), creatinine, blood urea nitrogen (BUN), alkaline phosphatase (ALP), waist circumference, body mass index (BMI= weight (kg)/height2 (m)), height and weight, family history of cardiovascular disease, physical inactivity, and insufficient consumption of fruits and vegetables.\u003c/p\u003e \u003cp\u003eIn this study, the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) was less than 2, 2 to 3.8, and more than 3.8, indicating favorable, moderate risk, and high risk of insulin resistance, respectively (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The participants were classified in three different groups in terms of physical activity based on the Scoring the International Physical Activity Questionnaire (IPAQ) recommendations for scoring protocol. The groups included low active (\u0026lt;600 MET\u0026ndash;minutes/week); moderate active (\u0026ge;600 MET\u0026ndash;minutes/week) and high active (\u0026ge;3000 MET\u0026ndash;minutes/week) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), considering the MET\u0026ndash;min/wk of the sum of walking, moderate-intensity physical activities, and vigorous-intensity physical activities. In terms of fruit and vegetable consumption, the subjects were divided into two groups according to the WHO recommendation, including high consumption (more than 400 grams of fruits and vegetables per day) and low consumption (less than 400 grams of fruits and vegetables per day) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). BMI categories were defined as follows: normal, BMI 20 to 24.9; overweight, BMI 25 to 29.9; obese I, BMI 30 to 34.9; obese II, BMI 35 to 39.9; morbid obesity, BMI \u0026ge;40(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eAll the data were entered in SPSS software version 22 and for descriptive analysis of data, mean and standard deviation or frequency and percentage were used. In order to investigate the relationships due to abnormality, Mann-Whitney U test and Chi-square test (for classification variables) were used. Multiple logistic regression model was used to determine the factors associated with MtS. The significance level (P value) was considered less than 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOut of 1933 patients with DM in this study, 1213 (62.8%) were female and 720 (37.2%) were male. The mean age of the participants was 55.92 \u0026plusmn; 8.17 years. The prevalence of MtS in this study was estimated to be 80% with a 95% confidence interval 81.8% -78.1%, so that 1546 patients had at least three of the 5 diagnostic factors of MtS. The prevalence of MtS was significantly higher in women (66.9%) compared to men (33.1%) (P-value\u0026lt;0.001). Moreover, the mean age of the subjects in the MtS group was significantly higher than the group without MtS (56.31\u0026plusmn;7.98 years compared to 54.37\u0026plusmn;8.74 years, P-value \u0026lt;0.001). The frequency distribution comparison of demographic and clinical characteristics of the patients in the two groups with and without MtS is given in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and Figure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. As can be seen, education level, marital status, smoking, alcohol consumption, history of hypertension, history of ischemic heart disease, family history of stroke, and consumption of fruits and vegetables were significantly different between the two groups (P-value \u0026lt;0.05). All the participants were low active and most of the subjects (84.7%) were in the group of low consumption of fruits and vegetables.\u003c/p\u003e\n\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of demographic and clinical characteristics in the two groups with and without MtS in type 2 diabetes mellitus\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(1933=n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWithout metabolic syndrome\u003c/p\u003e\n \u003cp\u003e(387=n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWith metabolic syndrome\u003c/p\u003e\n \u003cp\u003e(1546=n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(62-50) 57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(61-47) 5/55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(63-51) 57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(2/37) 720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(54) 209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1/33) 511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(8/62) 1213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(46) 178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(9/66) 1035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(2/11) 217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(9/5) 23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(5/12) 194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(8/88) 1716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1/94) 364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(5/87) 1352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(3/18) 353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(4/12) 48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(7/19) 305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiploma and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0/71) 1373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(7/67) 262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(9/71) 1111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(7/10) 207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(9/19) 77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(4/8) 130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFamily history of ischemic heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(3/14) 276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(3/16) 63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(8/13) 213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e208/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(7/85) 1657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(7/83) 324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(2/86) 1333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003efamily history of heart attack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(5/11) 223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(6/11) 45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(5/11) 178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e950/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(5/88) 1710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(4/88) 342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(5/88) 1368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFamily history of high blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(7/19) 380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(2/21) 82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(3/19) 298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e397/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(3/80) 1553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(8/78) 305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(7/80) 1248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFamily history of diabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0/22) 426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(5/24) 95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(4/21) 331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0/78) 1507\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(5/75) 292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(6/78) 1215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003efamily history of stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(3/8) 161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1/11) 43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(6/7) 118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e027/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(7/91) 1772\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(9/88) 344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(4/92) 1428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003econsumption of fruits and vegetables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(7/84) 888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(2/90) 194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(2/83) 694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e011/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(3/15) 161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(8/9) 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(8/16) 140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eMedium (first quarter-third quarter) for age and frequency (%) is reported for qualitative variables. In order to compare age in the two groups, Mann-Whitney test and to perform other comparisons Chi-square test were used.\u003c/p\u003e\n\u003cp\u003eThe prevalence of risk factors in the group without MtS included 33.9% abdominal obesity (95% confidence interval: 29.18-38.62), 19.7% obesity (95% confidence interval: 17.72-21.68), 27.1% hypertriglyceridemia (95% confidence interval: 22.67-31.53), 15.8% hypertension (95% confidence interval: 12.17-19.43), 15.8% smoking (95% confidence interval: 12.17- 19.43), 12.7% the history of ischemic heart disease (95% confidence interval: 9.39-16.01), 5.9% alcohol consumption (95% confidence interval: 3.55-8.25), and low HDL 1.3% (95% confidence interval: 0.18-2.42), respectively. The prevalence of risk factors in the MtS group was reported 80.5% hypertriglyceridemia (95% confidence interval: 78.54-82.46), 75.9% abdominal obesity (95% confidence interval: 73.76-78.04), 64% hypertension (95% confidence interval: 61.66-66.39), 48%low HDL (95% confidence interval: 45.51-50.49), 43.8% obesity (95% confidence interval: 41.33-46.27), 22.3% smoking (95% confidence interval: 20.22-24.38), 19% history of ischemic heart disease in (95% confidence interval: 18.80-19.20), and 9.4% alcohol consumption (95% confidence interval: 7.95-10.85), respectively. Figure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e reveals that the prevalence of the above factors in the two groups were statistically significant (P-value \u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eGiven the studied subjects were all patients with DM, all of them had at least one of the 5 factors of MtS. Therefore, the frequency distribution of the number of MtS factors included 4.4% only one factor (n=85), 15.6% two factors (n=302), 37.1% three factors (n=716), 31.1% four factors (n=601), and 11.7% five factors (n=226).\u003c/p\u003e\n\u003cp\u003eGiven the abnormal distribution of anthropometric indices and biochemical and laboratory indices, the Mann-Whitney non-parametric test was used for comparing the two groups, which is shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. The median of BMI, systolic blood pressure, diastolic blood pressure, heart rate, triglyceride, ALP, and TG to HDL ratio were significantly higher in the MtS group and HDL was significantly lower than the group without MtS.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of the median of anthropometric and laboratory indices of patients with type 2 diabetes mellitus in the two groups with and without MtS\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(1933=n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWithout metabolic syndrome (387=n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWith metabolic syndrome (1546=n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWaist circumference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(6/106-6/92) 5/99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(53/99-08/87) 05/94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(9/107-5/94) 2/101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(93/31-84/25) 66/28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(01/29-12/24) 45/26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(49/32-40/26) 30/29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSystolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(125-100) 115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(5/118-100) 108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(125-100) 115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiastolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(80-65) 70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(80-65)70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(80-65) 75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeart rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(82-70) 76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(80-68) 74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(83-70) 76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFasting blood sugar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(188-114) 144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(25/182-111) 143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(189-115) 145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTriglyceride\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(229-121) 165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(160-100) 126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(240-5/132) 179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(223-167) 193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(218-164) 5/191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(225-167) 194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e098/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(64-49) 56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(66-52) 59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(63-48) 56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(124-78) 100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(125-80) 99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(124-78) 100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e430/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCreatinine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(2/1-9/0) 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(2/1-9/0) 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(2/1-9/0) 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e143/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBUN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(17-12) 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(17-12) 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(17-12) 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e261/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(277-192) 232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(259-75/186) 219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(281-194) 235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTG to HDL ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(29/4-07/2) 96/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(84/2-60/1) 15/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(49/4-25/2) 22/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eMedian (first quarter-third quarter) is reported for the variables. Mann-Whitney test was used to compare the two groups. Low-Density Lipoproteins (LDL), High-Density Lipoproteins (HDL), Alkaline Phosphatase (ALP), Blood Urea Nitrogen (BUN)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eIn order to investigate the relationship between demographic characteristics, disease history, anthropometric indices, and biochemical factors with MtS, univariate logistic regression was performed for all the studied variables. Then, significant variables at the level of 0.1 were entered into the multiple logistic regression model using Backward LR method. According to the results of logistic regression model (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e), smoking, alcohol consumption, TG to HDL ratio, abdominal obesity, and hypertension were identified as factors associated with MtS in this study. So the risk of MtS was increased by smoking 5.60% (95% confidence interval: 3.67-8.55), alcohol consumption 4.1% (95% confidence interval: 2.32-7.23), TG to HDL ratio 1.42% (95% confidence interval: 1.30-1.55), abdominal obesity 13.73% (95% confidence interval: 9.77-19.29), and hypertension 13.54% (95% confidence interval: 9.55-19.19), respectively. Considering that hypertension and abdominal obesity are the 5 causes of MtS, it is associated with a high risk of developing MtS.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariate logistic regression results\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTG to HDL ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(55/1-30/1) 42/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAbdominal obesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(29/19-77/9) 73/13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(55/8-67/3) 60/5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAlcohol consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003cp\u003e001/0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(23/7-32/2) 098/4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eref\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003cp\u003e011/0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(19/19-55/9) 54/13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eMultiple logistic regression model using Backward LR method. High-Density Lipoproteins (HDL), Triglyceride (TG)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eCardiovascular diseases are the leading cause of death and disability in diabetic patients (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). high blood pressure, hyperlipidemia, MtS, and smoking are important risk factors for cardiovascular disease (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), and the association of these factors with cardiovascular disease is completely identified (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The results of the present study revealed that in patients with DM smoking, alcohol consumption, triglyceride to HDL ratio, abdominal obesity, and hypertension were identified as the factors associated with MtS.\u003c/p\u003e \u003cp\u003eMtS is a set of multiple risk factors for atherosclerotic cardiovascular disease and DM (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). MtS is strongly associated with DM. In this type of diabetes, there is insulin resistance with secondary hyperinsulinemia and it is often associated with high blood pressure, dyslipidemia, atherosclerosis, and most importantly obesity, especially central obesity. Etiology of MtS consists of separate components of the MtS (such as hypertension, DM, dyslipidemia) causing complex conditions (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The prevalence of MtS in this study was estimated to be 80%. Its prevalence according to IDF criteria in people with Type 2 Diabetes Mellitus in the study by Moreira et al. was reported to be 74.3% *. It was also 69.5% in the study by AlSaraj et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Different prevalence of MtS in populations, in addition to methodological differences, could be due to various nutritional, epidemiological, and demographic transitions (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), as well as ethnic (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), social, and environmental (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) disparities.\u003c/p\u003e \u003cp\u003eIn this study, the prevalence of hypertension in the group without MtS was 15.8% and in the MtS group was 64%. However, the prevalence of hypertension with diabetes varied in different ethnic, racial, and social groups (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In previous studies, the prevalence of hypertension in patients with diabetes, covering more than 30,000 people in different areas, 70% of diabetic patients have been reported to have hypertension (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). This rate is more consistent with the blood pressure statistics in diabetic patients with MtS in this study.\u003c/p\u003e \u003cp\u003eIn the current study, smoking, alcohol consumption, and TG to HDL ratio were also identified as factors associated with MtS in patients with DM. These results were confirmed by Lindsay et al. and Mottillo et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Slagter et al. reported that alcohol and cigarette consumption increase the risk of MtS and some of its components in a dose-dependent manner (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). It has been found that high levels of LDL, high blood pressure, and smoking are the most important risk factors for cardiovascular disease in DM and low HDL cholesterol, insulin resistance, hyperglycemia, and inflammation are also predictors of cardiovascular complications (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevious studies have reported that obesity, especially central obesity, is the main underlying cause of MtS, causing a genetic predisposition for other risk factors, such as dyslipidemia and hypertension (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). In the present study, the prevalence of abdominal obesity in diabetic patients without MtS was 33.9%, which reached 75.9% in DM patients with MtS. In the study by Cheng et al., abdominal obesity was reported in 91.6% of people with DM (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), which is higher than the results of the present study. Central obesity is a major risk factor for MtS and diabetes (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), also increases the risk of dyslipidemia and coronary artery disease (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLack of access to complete information in the files and the defects in the files were among the most important limitations of this study, which were controlled as much as possible by removing incomplete files and replacement.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe high prevalence of MtS in patients with DM in Rafsanjan adult cohort study indicates the importance of this issue. Therefore, high risk patients can be identified using MtS screening in primary health centers, and they can benefit from timely multifactorial interventions. Reducing smoking and alcohol consumption, and controlling hypertension, hyperlipidemia, and overweight are some of the suggested solutions in this regard.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCVD, Cardiovascular disease; MtS, metabolic syndrome; DM, diabetes mellitus; RCS, Rafsanjan Cohort Study; PERSIAN, Prospective Epidemiological Research Studies in IrAN; IDF, International Diabetes Federation; NCEP-ATPIII, the National Cholesterol Education Program-Adult Treatment Panel; WHO, World Health Organization; LDL, low-density lipoprotein; HDL, High Density Lipoprotein; BUN, blood urea nitrogen; ALP, alkaline phosphatase; BMI, body mass index.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy was carried out in accordance with ethical guidelines of prospective epidemiological studies of the population in Iran (PERSIAN cohort) and ethical Committee for Rafsanjan University of Medical Sciences, Rafsanjan, Iran (IR.RUMS.REC.1399.050). All patients provided written informed consent. Our present medical research was conducted according to the principles expressed in the 1975 Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to PERSIAN cohort policy on availability of health care registers, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Iranian Ministry of Health and Medical Education has contributed to the funding used in the PERSIAN Cohort through Grant No. 700/534. This study has also been supported by the Vice Chancellery for Research \u0026amp; Technology of Rafsanjan University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZK and GhB initiated the study and were responsible for elaborating the concept of it, and critically revised the manuscript. ZK and MA contributed to the extraction, analysis and interpretation of the data. ZK, GhB, HAand AEN contributed to the quality assessment of data, data analysis and interpretation, and drafted the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the Clinical Research Development Unit for its support and collaboration in Ali-Ibn Abi-Talib hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e2 Department of Family Medicine, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 3 Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 4 Department of Internal Medicine, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEsteghamati A, Larijani B, Aghajani MH, Ghaemi F, Kermanchi J, Shahrami A, et al. 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Diabetes Care. 2017;40(7):985.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLindsay RS, Howard BV. Cardiovascular risk associated with the metabolic syndrome. Current diabetes reports. 2004;4(1):63\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. Journal of the American College of Cardiology. 2010;56(14):1113\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSlagter SN, van Vliet-Ostaptchouk JV, Vonk JM, Boezen HM, Dullaart RP, Kobold ACM, et al. Combined effects of smoking and alcohol on metabolic syndrome: the LifeLines cohort study. PloS one. 2014;9(4):e96406.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaakso M, Kuusisto J. Insulin resistance and hyperglycaemia in cardiovascular disease development. Nature Reviews Endocrinology. 2014;10(5):293\u0026ndash;302.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZafar U, Khaliq S, Ahmad HU, Manzoor S, Lone KP. Metabolic syndrome: an update on diagnostic criteria, pathogenesis, and genetic links. Hormones. 2018;17(3):299\u0026ndash;313.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng Y, Zhang H, Chen R, Yang F, Li W, Chen L, et al. Cardiometabolic risk profiles associated with chronic complications in overweight and obese type 2 diabetes patients in South China. PloS one. 2014;9(7):e101289.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTyrovolas S, Koyanagi A, Garin N, Olaya B, Ayuso-Mateos JL, Miret M, et al. Diabetes mellitus and its association with central obesity and disability among older adults: a global perspective. Experimental Gerontology. 2015;64:70\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOnat A, Avcı GŞ, Barlan M, Uyarel H, Uzunlar B, Sansoy V. Measures of abdominal obesity assessed for visceral adiposity and relation to coronary risk. International journal of obesity. 2004;28(8):1018\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cardiovascular Risk Factors, Syndrome, Metabolic, Diabetes Mellitus, Prospective Epidemiological Research Studies in IrAN (PERSIAN)","lastPublishedDoi":"10.21203/rs.3.rs-1186156/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1186156/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCardiovascular disease (CVD) is the leading causes of death and disability in diabetes. This study aimed to determine the prevalence of cardiovascular risk factors in people with and without metabolic syndrome (MtS) in diabetes mellitus (DM).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was part of Rafsanjan Cohort Study (RCS).as part of the comprehensive PERSIAN (Prospective Epidemiological Research Studies in IrAN) on adults with and without MtS in DM. CVD risk factors, including gender, age, blood pressure, dyslipidemia, smoking, alcohol consumption, fasting blood sugar, creatinine, blood urea, waist circumference, body mass index, family history, physical inactivity, fruit and vegetable consumption were collected in the PERSIAN Cohort Questionnaire. The data were analyzed by SPSS software version 22.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of MtS in 1933 participants was estimated to be 80% (95% confidence interval 81.8% -78.1%). In the logistic regression model, smoking, alcohol consumption, triglyceride to HDL (High Density Lipoprotein) ratio, abdominal obesity, and hypertension were identified as the factors associated with MtS.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOur results show that Based on our study, the prevalence of cardiovascular risk factors in DM was high. Reducing smoking and alcohol consumption and controlling hypertension, hyperlipidemia, and overweight are the suggested solutions in this field.\u003c/p\u003e","manuscriptTitle":"The Prevalence of Cardiovascular Risk Factors in Patients with and Without Metabolic Syndrome in Diabetes Mellitus: A Study Based on Rafsanjan Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-01-20 16:04:34","doi":"10.21203/rs.3.rs-1186156/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c211e9f7-7966-4832-9373-e83069337623","owner":[],"postedDate":"January 20th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-02-21T09:59:17+00:00","versionOfRecord":[],"versionCreatedAt":"2022-01-20 16:04:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1186156","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1186156","identity":"rs-1186156","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}