Metabolic Syndrome Linked to Earlier Incidence of Heart Attack, Stroke

Middle-aged adults with metabolic syndrome have heart attacks and strokes 2 years earlier than their peers, according to a study presented at the European Society of Cardiology Congress 2023.

“Many people in their 40s and 50s [who] have a bit of fat around the middle and marginally elevated blood pressure, cholesterol, or glucose, but feel generally well, are unaware of the risks and do not seek medical advice,” study author Dr. Lena Lönnberg, of Västmanland County Hospital in Västerås, Sweden, said in a press release. “This scenario, called metabolic syndrome, is a growing problem in Western populations where people are unknowingly storing up problems for later in life. This is a huge missed opportunity to intervene before heart attacks and strokes that could have been avoided occur.”

Approximately 31% of the global population has metabolic syndrome, and previous studies have shown that this population has a higher risk of diabetes, heart disease, stroke, and early death. The specific goal of this analysis was to examine the link between asymptomatic metabolic syndrome in midlife and subsequent cardiovascular disease and death.

Researchers enrolled 34,269 adults in their 40s and 50s who attended a cardiovascular screening program between 1990 to 1999. Patients in the population of interest had all gone to their primary health care center for a clinical examination and had recorded data, including height, weight, blood pressure, total cholesterol, blood glucose, and waist and hip circumference. The subjects had also completed a questionnaire about lifestyle habits, previous history of cardiovascular disease and diabetes, and socioeconomic factors such as education. Participants were classified as having metabolic syndrome if they had 3 or more of the following:

• A waist circumference ≥102 cm for men and ≥88 cm for women
• Total cholesterol ≥6.1 mmol/l
• Systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥85 mm Hg
• Fasting plasma glucose ≥5.6 mmol/l

The final analysis included 5084 individuals with metabolic syndrome and a control group of 10,168 individuals without metabolic syndrome. Over a median follow-up of 27 years, the study showed that 26% of participants with metabolic syndrome died compared with 19% of controls; individuals with metabolic syndrome were 30% more likely to die than their counterparts.

Moreover, the study found that nonfatal cardiovascular events, namely heart attack and stroke, occurred in 32% of participants with metabolic syndrome and 22% of controls; individuals in the metabolic syndrome group had a 35% greater risk of heart attack and stroke. Investigators noted that the average time to the first nonfatal heart attack or stroke was 16.8 years in the metabolic syndrome group and 19.1 years in the control group, a 2.3-year difference.

“The results underline the importance of early detection of risk factors through health screening programs so that preventive actions can be taken to prevent heart attack, stroke, and premature death,” said Dr. Lönnberg. “As a general rule of thumb, even if you feel well, check your blood pressure every year, avoid smoking, keep an eye on your waist circumference, and, last but definitely not least, be physically active every day.”