Prevalence and Determinants of Coronary Artery Calcification in Adults With Metabolic Syndrome: A Systematic Review and Meta‐Analysis

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 48; no. 6; pp. e70156 - n/a
• Main Authors: Ullah, Aftab, Jan, Asif, Kareem, Hasan Naeem, Babaresh, Wahby Mohammed Ahmed, Rahim, Abdur, Ali, Syed Shaukat, Shah, Waheed Ali, Hajwal, Salim K., Hermis, Alaa Hamza, Jawad, Mustafa Kareem, Salman, Sajjad Sadeq, Ajel, Murtadha Abdulridha, Alsuwayidi, Fatimah Saleh, Alobaidan, Fadhilah N., Kadhem, Ameer Hasan
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.06.2025; John Wiley and Sons Inc
• Subjects: Adult; Adults; Atherosclerosis; Boolean; Calcification; Cardiovascular disease; Cardiovascular diseases; cardiovascular risk; coronary artery calcification; Coronary Artery Disease - diagnosis; Coronary Artery Disease - epidemiology; Coronary Artery Disease - etiology; Coronary vessels; Diabetes; Epidemiology; Global Health; Grey literature; Health sciences; Humans; Hyperglycemia; Hypertension; Insulin resistance; Intervention; Male; Medical Subject Headings-MeSH; Meta-analysis; Metabolic disorders; Metabolic syndrome; Metabolic Syndrome - complications; Metabolic Syndrome - diagnosis; Metabolic Syndrome - epidemiology; Obesity; Prevalence; Review; Risk Assessment; Risk Factors; Software; Systematic review; Tomography; Type 2 diabetes; Vascular Calcification - diagnosis; Vascular Calcification - diagnostic imaging; Vascular Calcification - epidemiology; Vascular Calcification - etiology; Vein & artery diseases; metabolic syndrome; prevalence; cardiovascular risk; coronary artery calcification; meta‐analysis
• ISSN: 0160-9289; 1932-8737; 1932-8737
• DOI: 10.1002/clc.70156

ABSTRACT Background Metabolic syndrome (MetS) is a recognized risk factor for coronary artery calcification (CAC), a subclinical marker of atherosclerosis associated with elevated cardiovascular risk. However, the prevalence and determinants of CAC in individuals with MetS have not been comprehensively synthesized. This systematic review and meta‐analysis aimed to estimate the pooled prevalence of CAC and identify associated factors among adults with MetS. Methods A comprehensive search was conducted in PubMed, LILACS, Web of Science, Embase, Scopus, AJOL, and gray literature through December 2024, following PRISMA 2020 guidelines. Eligible studies included adults (≥ 18 years) with MetS, defined by established criteria, and reported CAC scores via validated CT imaging techniques. Observational studies and RCTs were included. Study quality was assessed using the Joanna Briggs Institute checklist. Pooled estimates were derived using a random‐effects model, and heterogeneity was assessed with the I2 statistic. Results In total, 17 studies comprising 20 745 individuals were included. The pooled prevalence of CAC in adults with MetS was 39.8% (95% CI: 28.4%–52.5%), with wide variation across study design, geography, and imaging modality. Males had a higher CAC prevalence (RR: 2.00), and MetS was linked to increased CAC scores (SMD: 0.10) and odds of calcification (OR: 1.34–1.50). Subgroup analyses showed variability by region and CT modality. High CAC scores were associated with elevated cardiovascular event rates. Conclusion CAC affects ~40% of adults with MetS and is associated with higher cardiovascular risk. These findings support the integration of CAC screening in MetS management strategies. This systematic review and meta‐analysis quantified the prevalence and determinants of coronary artery calcification (CAC) among adults with metabolic syndrome (MetS). Findings reveal a substantial burden of CAC in this population, with key determinants including age, hypertension, and dyslipidemia. These results underscore the importance of targeted CAC screening to enhance cardiovascular risk stratification in individuals with MetS. Summary What is currently known about this topic? Metabolic syndrome (MetS) increases cardiovascular risk. Coronary artery calcium (CAC) is a key marker of subclinical atherosclerosis. CAC prevalence varies by sex, region, and imaging modality. What is the key research question? What is the pooled prevalence of CAC in adults with MetS, and what factors influence CAC scores? What is new? Pooled CAC prevalence in MetS patients is 42.7%. Males and certain regions (e.g., USA, Serbia) show higher CAC prevalence. Electron beam CT (EBCT) detects CAC more frequently than multislice CT (MSCT). How might this study influence clinical practice? CAC scoring should be integrated into cardiovascular risk stratification for MetS patients, especially in high‐risk populations.