Ischemic Heart Disease and Stroke Risk Not Uniform Across Metabolic Syndrome Subtypes

Different subtypes of metabolic syndrome (MetS) have varying prevalence rates of ischemic heart disease (IHD) and stroke, according to results of a study published in the Journal of the American Heart Association.

Individuals who have at least 3 of the 5 risk factors for MetS (elevated waist circumference [WC], triglycerides, blood pressure [BP], or fasting plasma glucose [FPG] and low high-density lipoprotein cholesterol [HDL-C]) meet the criteria for MetS.

To evaluate MetS criteria-specific trends in IHD and stroke, data from the STEPwise Approach to Noncommunicable Diseases Risk Factor Surveillance (Iran STEP) Survey conducted in 2021 were assessed. Study participants (N=18,083) aged older than 25 years were grouped into 6 MetS subgroups, in which Groups 1 to 3 met 3 components combined with neither high BP nor FPG (Group 1), either high BP or FPG (Group 2), and both high BP and FPG (Group 3); Groups 4 and 5 met 4 components combined with either high BP or FPG (Group 4) or both high BP and FPG (Group 5); and Group 6 met all criteria.

Most study participants were women (55.64%). The prevalence of MetS was higher among women (57.77%) than men (49.69%).

Not all MetS clusters illustrated the same association with IHD and stroke.

The rates of elevated WC were 91.41% and 52.54%, elevated triglycerides were 63.19% and 10.51%, elevated BP were 70.22% and 21.31%, elevated FPG were 60.59% and 13.3%, and low HDL-C were 87.33% and 44.75% in patients with MetS and without MetS, respectively.

People with and without MetS had IHD event rates of 10.64% and 4.32% (P <.001), respectively, and stroke event rates of 1.92% and 0.93% (P <.001), respectively.

In the adjusted analyses, MetS was associated with increased risk for IHD (adjusted odds ratio [aOR], 1.70; 95% CI, 1.40-2.07; P <.001) but not stroke (aOR, 1.30; 95% CI, 0.89-1.89; P =.178). Stratified by gender, both women (aOR, 1.43; 95% CI, 1.06-1.93; P =.02) and men (aOR, 2.02; 95% CI, 1.57-2.60; P <.001) with MetS were at higher risk for IHD but not for stroke (aOR range, 1.19-1.48; both P ³.129).

Stratified by MetS group, risk for IHD was highest in Group 6 (aOR, 2.55; 95% CI, 1.93-3.35; P <.001), followed by Group 5 (aOR, 2.40; 95% CI, 1.84-3.13; P <.001) and Group 3 (aOR, 1.66; 95% CI, 1.11-2.49; P =.014) compared with the no MetS group in the multivariable analysis. In the stroke analysis, only Group 5 was at higher risk for stroke than individuals without MetS (aOR, 1.86; 95% CI, 1.17-2.97; P =.009).

Using individuals who did not meet any MetS criteria as the comparator group, IHD risk was elevated among individuals in Groups 6 (aOR, 6.69; 95% CI, 3.52-12.68; P <.001), 5 (aOR, 6.38; 95% CI, 3.38-12.03; P <.001), 3 (aOR, 4.48; 95% CI, 2.21-9.10; P <.001), 2 (aOR, 3.39; 95% CI, 1.78-6.45; P <.001), and 4 (aOR, 2.87; 95% CI, 1.50-5.47; P =.001) and no trends in stroke risk were observed.

The major limitation of this study was the reliance on self-reported IHD and stroke outcomes.

The study authors concluded, “Not all MetS clusters illustrated the same association with IHD and stroke.”

This article originally appeared on The Cardiology Advisor