Different Combinations of the Metabolic Syndrome Criteria and Cardiovascular Disease

ABSTRACT Background The metabolic syndrome (MetS) has previously been linked to incident cardiovascular disease (CVD). It is however not known if certain combinations of MetS criteria show a higher risk than others. Methods We used data from UK biobank in which 388,800 individuals had data on MetS using the five harmonized NCEP criteria. The cohort was followed for a median of 12.6 years. A composite CVD outcome was used (myocardial infarction, ischemic stroke or heart failure). Results The risk of incident CVD (n= 22,572) increased in a fairly linear fashion with increasing number of MetS criteria. In the groups showing three MetS criteria, thus fulfilling the definition of MetS, the highest risk was seen in those with the combination of the glucose + waist circumference + HDL criteria (HR 3.90, 95%CI 3.17-4.80). In the group with four criteria, the highest HRs were seen in the groups not including triglyceride or the blood pressure criteria (HR 3.96, 95%CI 3.57-4.59 and HR 3.79, 95%CI 3.13-4.59, respectively). The risk of CVD in those with all five criteria was in the same order (HR 3.65, 95%CI 3.33-4.01). Mendelian randomization indicated a causal role of MetS for coronary heart disease (CHD) and heart failure, but not ischemic stroke, while use of polygenetic risk scores for CHD and ischemic stroke were related to MetS criteria in a similar fashion as observational data. Conclusion Certain combinations of risk factors in individuals with the metabolic syndrome criteria showed a higher risk of future CVD than others.