Association of the Metabolic Syndrome With History of Myocardial Infarction and Stroke in the Third National Health and Nutrition Examination Survey

TLDR

Metabolic syndrome, a cluster of cardiovascular risk factors, has attracted growing clinical interest, yet its link to morbidity remains poorly characterized. This study assessed the cross‑sectional association between metabolic syndrome and history of myocardial infarction and stroke in a large national sample. Using logistic regression adjusted for age, sex, race, and smoking, the authors evaluated the syndrome and its five components in 10,357 NHANES III participants. Metabolic syndrome was independently associated with MI (OR 2.01), stroke (OR 2.16), and combined MI/stroke (OR 2.05), and several components—insulin resistance, low HDL‑C, hypertension, and hypertriglyceridemia—were also significantly linked to MI/stroke.

Abstract

The combination of cardiovascular risk factors known as the metabolic syndrome is receiving increased attention from physicians, but data on the syndrome's association with morbidity are limited.Applying National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria, we evaluated 10 357 NHANES III subjects for the 5 component conditions of the metabolic syndrome: insulin resistance, abdominal obesity based on waist circumference, hypertriglyceridemia, low HDL cholesterol (HDL-C), and hypertension, as well as the full syndrome, defined as at least 3 of the 5 conditions. Logistic regression was used to estimate the cross-sectional association of the syndrome and each of its 5 component conditions separately with history of myocardial infarction (MI), stroke, and either MI or stroke (MI/stroke). Models were adjusted for age, sex, race, and cigarette smoking. The metabolic syndrome was significantly related in multivariate analysis to MI (OR, 2.01; 95% CI, 1.53 to 2.64), stroke (OR, 2.16; 95% CI, 1.48 to 3.16), and MI/stroke (OR, 2.05; 95% CI, 1.64 to 2.57). The syndrome was significantly associated with MI/stroke in both women and men. Among the component conditions, insulin resistance (OR, 1.30; 95% CI, 1.03 to 1.66), low HDL-C (OR, 1.35; 95% CI, 1.05 to 1.74), hypertension (OR, 1.44; 95% CI, 1.00 to 2.08), and hypertriglyceridemia (OR, 1.66; 95% CI=1.20 to 2.30) were independently and significantly related to MI/stroke.These results indicate a strong, consistent relationship of the metabolic syndrome with prevalent MI and stroke.