Screening for Metabolic Syndrome in Primary Care

Objective People with metabolic syndrome (MetS) have an increased risk of developing type 2 diabetes and cardiovascular disease. Early detection might modify cardiometabolic risk factors and prevent cardiovascular disease. We aimed to evaluate 1) the feasibility and yield of screening for MetS with self-measurement of waist circumference as a first step, followed by ‘usual care’ in general practice, and 2) the one- and three-year results. Methods All patients aged 20-70 years from five general practices in IJsselstein, the Netherlands, not previously diagnosed with diabetes, hypertension or dyslipidaemia (‘apparently healthy’, n = 11.862), were eligible for screening. They received a tape measure with an instruction leaflet, mailed to their home, with the request to measure their waist circumference. Those with an increased waist circumference (central obesity; ³ 88/102 cm for women/men) were invited for examinations to determine whether or not they had MetS (NCEP ATP III criteria). After the screening, participants were asked to contact their general practice for their screening results; people with screen-detected MetS were subsequently invited to visit the general practice for usual care according to the existing guidelines. After three years, MetS status was re-evaluated. Results 1.721 people with an increased self-measured waist circumference underwent all procedures. Among them, 473 new MetS cases were detected, of which 40% in people younger than 45 years. The correlation between the waist circumference as measured by participants and investigators was good. The MetS prevalence among people aged 20-70 in IJsselstein was 15.5%. Only 39% of the people with MetS were already known to have cardiometabolic risk factors. After screening, 72% of the people with screen-detected MetS spontaneously contacted the practice. After one year, in 84% acardiovascular risk profile was recorded. Half of the participants reported to have increased their physical activity; 17% of the smokers quit smoking. Average weight loss was 2.1 kg. At three-year follow-up, we observed a significant improvement in all MetS components, except for glucose level. The remission rate among the 194 participants was 53%. 32% of the people with central obesity as their only MetS component at screening, developed at least one additional MetS component, 7% had developed MetS. The number of MetS patients with sufficient physical activity did not significantly increase between screening and follow-up. People with overweight or obesity did not consider their condition to be very serious, and experienced a moderate level of personal control on their condition. Conclusions A general practitioner initiated screening for MetS with self-measurement of waist circumference as the first step, proved to be feasible and reliable. A substantial number of people younger than 45 years with an increased cardiovascular risk was detected. Screening, followed by the advice to contact the general practice for lifestyle counselling and treatment had a substantial spontaneous follow-up, with promising changes in physical activity, weight loss and smoking abstinence in the first year after screening. At three-year follow-up, we observed significant improvements in cardiometabolic risk profile and a remission rate of the MetS of 53%. A screening interval of more than three years seems justifiable, which makes our strategy cheaper and more attractive to implement. The screening procedure and subsequent follow-up care fit in current practice, which facilitates implementation.