CARDIOVASCULAR MEDICINE

Metabolic syndrome and risk for heart failure in middle-aged men

E Ingelsson¹, J Ärnlöv¹, L Lind^2,, J Sundström^1,*

¹ Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala, Sweden
² Department of Medical Sciences, Uppsala University, Uppsala, Sweden

Correspondence to:
Dr Erik Ingelsson
Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala Science Park, SE-751 85 Uppsala, Sweden; erik.ingelsson{at}pubcare.uu.se

Objective: To explore metabolic syndrome as a possible risk factor for development of heart failure (HF).

Design: Community-based cohort study.

Setting: Uppsala, Sweden.

Participants: 2314 50-year-old men free from HF, myocardial infarction and valvular disease at baseline were enrolled between 1970 and 1974 and were followed up until the age of 70. A modified National Cholesterol Education Program definition of metabolic syndrome was used with body mass index in the place of waist circumference.

Main outcome measure: First hospitalisation for HF.

Results: In multivariable Cox proportional hazards models adjusted for established risk factors for HF (hypertension, diabetes, ECG left ventricular hypertrophy, smoking and body mass index), the presence at baseline of metabolic syndrome (hazard ratio 1.66, 95% confidence interval (CI) 1.02 to 2.70) was a predictor of subsequent HF. This relation was even stronger after adjustment for the presence of an acute myocardial infarction during follow up in addition to the other established risk factors for HF (hazard ratio 1.80, 95% CI 1.11 to 2.91).

Conclusion: Metabolic syndrome was a significant predictor of HF, independent of established risk factors for HF including an interim myocardial infarction, during two decades of follow up in a community-based sample of middle-aged men. This implies that metabolic syndrome provides important risk information beyond that of established risk factors for HF.

Abbreviations: ATP III, Adult Treatment Panel III; BMI, body mass index; ESR, erythrocyte sedimentation rate; HF, heart failure; ICD, International Classification of Diseases; NCEP, National Cholesterol Education Program; NHANES III, Third National Health and Nutrition Examination Survey; ULSAM, Uppsala Longitudinal Study of Adult Men

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