Metabolic syndrome and risk of acute myocardial infarction a case-control study of 26,903 subjects from 52 countries

• Published in: Journal of the American College of Cardiology Vol. 55; no. 21; pp. 2390 - 2398
• Main Authors: Mente, Andrew, Yusuf, Salim, Islam, Shofiqul, McQueen, Matthew J, Tanomsup, Supachai, Onen, Churchill L, Rangarajan, Sumathy, Gerstein, Hertzel C, Anand, Sonia S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 25.05.2010
• Subjects: Abdomen; Age Distribution; Blood Chemical Analysis; Cardiology; Cardiovascular disease; Case-Control Studies; Cholesterol; Comorbidity; Confidence Intervals; Ethnic Groups - statistics & numerical data; Female; Heart attacks; Humans; International Cooperation; Male; Medical research; Metabolic syndrome; Metabolic Syndrome - diagnosis; Metabolic Syndrome - epidemiology; Metabolic Syndrome - ethnology; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Myocardial Infarction - ethnology; Obesity; Odds Ratio; Prevalence; Prognosis; Reference Values; Risk Assessment; Severity of Illness Index; Sex Distribution; Survival Analysis
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2009.12.053

This study examines the risk of acute myocardial infarction (MI) conferred by the metabolic syndrome (MS) and its individual factors in multiple ethnic populations. The risk of the MS on MI has not been well characterized, especially in multiple ethnic groups. Participants in the INTERHEART study (n = 26,903) involving 52 countries were classified using the World Health Organization (WHO) and International Diabetes Federation (IDF) criteria for MS, and their odds ratios (ORs) for MI were compared with the individual MS component factors. The MS is associated with an increased risk of MI, both using the WHO (OR: 2.69; 95% confidence interval [CI]: 2.45 to 2.95) and IDF (OR: 2.20; 95% CI: 2.03 to 2.38) definitions, with corresponding population attributable risks of 14.5% (95% CI: 12.7% to 16.3%) and 16.8% (95% CI: 14.8% to 18.8%), respectively. The associations are directionally similar across all regions and ethnic groups. Using the WHO definition, the association with MI by the MS is similar to that of diabetes mellitus (OR: 2.72; 95% CI: 2.53 to 2.92) and hypertension (OR: 2.60; 95% CI: 2.46 to 2.76), and significantly stronger than that of the other component risk factors. The clustering of > or =3 risk factors with subthreshold values is associated with an increased risk of MI (OR: 1.50; 95% CI: 1.24 to 1.81) compared with having component factors with "normal" values. The IDF definition showed similar results. In this large-scale, multi-ethnic, international investigation, the risk of MS on MI is generally comparable to that conferred by some, but not all, of its component risk factors. The characterization of risk factors, especially continuous variables, as dichotomous will underestimate risk and decrease the magnitude of association between MS and MI.