Metabolic Syndrome Doubles Risk for MI, Stroke
posted 08/25/03
The metabolic syndrome is associated with a twofold increase in the risk for myocardial infarction and stroke.

Dr. Michael H. Criqui reported the results at a symposium sponsored by the Giovanni Lorenzini Medical Foundation.

Population survey data also showed a strong association between the risk for MI/stroke and four out of five individual components of the metabolic syndrome, as established by the National Cholesterol Education Program (NCEP). The data came from 10,768 adults aged 20-89 years who participated in the third National Health and Nutrition Examination Survey (1988-1994) population and who had blood samples taken after at least 7 hours of fasting.

“The data suggest the importance of managing the metabolic syndrome overall, and the individual component conditions, given the strong relationship with cardiovascular morbidity,” said Dr. Criqui, professor of medicine at the University of California, San Diego.

In the study sample, which included subjects with diabetes and those on antihypertensive agents, the prevalence of self-reported prior MI among the 22% who met the NCEP criteria was twice (odds ratio 2.01) that of those who did not meet the criteria, while the risk for stroke was even higher (2.16) and the odds of having one or the other was intermediate (2.05).

Metabolic syndrome increased the risk of having either MI or stroke similarly among men (1.9) and women (2.2), after adjustment for age, race, and smoking, Dr. Criqui said.

According to the NCEP, the diagnosis of metabolic syndrome is based on meeting at least three of five criteria: fasting glucose at least 110 mg/dL; triglycerides at least 150 mg/dL; HDL cholesterol below 40 mg/dL in men or below 50 mg/dL in women; blood pressure at least 130/85 mm Hg; and central obesity (abdominal waist circumference greater than 40 inches for men and greater than 35 inches for women).

Among the five NCEP criteria, an elevated triglyceride level was the strongest independent predictor of increased risk for MI and/or stroke. Hypertension, insulin resistance, and low HDL cholesterol also were significant independent predictors. Waist circumference was not an independent predictor because it may have acted through triglyceride levels, low HDL levels, and insulin resistance, explained Dr. Criqui, also professor and vice chair of family and preventive medicine at the university.

Other predictors of MI and/or stroke included black race (largely due to strokes) and current smoking. Mexican Americans had a slightly lower risk. Total cholesterol was not related to MI or stroke, he reported.

Exclusion of the 845 diabetics in the sample (7.8% of the total) reduced the risk only slightly, to an odds ratio of 1.90 for MI and/or stroke, 1.89 for MI, and 2.02 for stroke. “So, metabolic syndrome poses a risk independent of clinical diabetes,” Dr. Criqui noted.

This finding correlates with several previous studies in which postprandial lipid and glucose values were found to be better predictors of outcome than were fasting levels, Dr. Criqui said.

Source: Diabetes In Control Dot Com.

August News Article Index