4.7 Article

Metabolic Syndrome and Risk of Acute Myocardial Infarction A Case-Control Study of 26,903 Subjects From 52 Countries

Journal

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 55, Issue 21, Pages 2390-2398

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2009.12.053

Keywords

myocardial infarction; metabolic syndrome; diabetes mellitus; ethnicity; epidemiology

Funding

  1. Canadian Institutes of Health Research
  2. Heart and Stroke Foundation of Ontario
  3. International Clinical Epidemiology Network
  4. AstraZeneca
  5. Novartis
  6. Hoechst Marion Roussel [now Aventis]
  7. Knoll Pharmaceuticals [now Abbott]
  8. Bristol-Myers Squibb
  9. Sanofi-Synthelabo
  10. Heart and Stroke Foundation of Canada

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Objectives This study examines the risk of acute myocardial infarction (MI) conferred by the metabolic syndrome (MS) and its individual factors in multiple ethnic populations. Background The risk of the MS on MI has not been well characterized, especially in multiple ethnic groups. Methods 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. Results 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 >= 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. Conclusions 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. (J Am Coll Cardiol 2010;55:2390-8) (C) 2010 by the American College of Cardiology Foundation

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