Global coronary heart disease risk assessment of individuals with the metabolic syndrome in the U.S

OBJECTIVE—Although metabolic syndrome is related to an increased risk of coronary heart disease (CHD) events, individuals with metabolic syndrome encompass a wide range of CHD risk levels. This study describes the distribution of 10-year CHD risk among U.S. adults with metabolic syndrome.RESEARCH DESIGN AND METHODS—Metabolic syndrome was defined by the modified National Cholesterol Education Program (NCEP)/Third Adult Treatment Panel (ATP III) definition among 4,293 U.S. adults aged 20–79 years in the National Health and Nutrition Examination Survey 2003–2004. Low-, moderate-, moderately high–, and high-risk statuses were defined as <6, 6 to <10, 10–20, and >20% probability of CHD in 10 years (based on NCEP/ATP III Framingham risk score algorithms), respectively; those with diabetes or preexisting cardiovascular disease were assigned to high-risk status.RESULTS—The weighted prevalence of metabolic syndrome by NCEP criteria in our study was 29.0% overall (30.0% in men and 27.9% in women, P = 0.28): 38.5% (30.7% men and 46.9% women) were classified as low risk, 8.5% (7.9% men and 9.1% women) were classified as moderate risk, 15.8% (23.4% men and 7.6% women) were classified as moderately high risk, and 37.3% (38.0% men and 36.5% women) were classified as high risk. The proportion at high risk increased with age but was similar among Hispanics, non-Hispanic whites, and non-Hispanic blacks.CONCLUSIONS—Although many subjects with metabolic syndrome have a low calculated risk for CHD, about half have a moderately high or high risk, reinforcing the need for global risk assessment in individuals with metabolic syndrome to appropriately target intensity of treatment for underlying CHD risk factors.The metabolic syndrome is a cluster of risk factors often linked to insulin resistance that has been shown to increase the risk for development of cardiovascular disease (CVD). Individuals with metabolic syndrome have an increased risk of coronary heart disease (CHD) and CVD mortality (1,2). Global risk assessment using Framingham risk prediction algorithms is often the initial evaluation of CHD risk in subjects with multiple risk factors, including those with metabolic syndrome (3). Although it is often assumed that individuals with metabolic syndrome have a high risk of CVD, many have only borderline elevations in risk factors and thus may actually have either a low or intermediate risk of CVD (4). Therefore, assessment of global risk of CHD in individuals with metabolic syndrome may be helpful to most appropriately target the intensity of cardiometabolic risk factor interventions for prevention of diabetes or cardiovascular disease.The aim of this article was to calculate the global risk of CHD in adults with metabolic syndrome in the U.S. to better characterize the diversity in their risk of CHD using the data from the National Health and Nutrition Examination Survey (NHANES) 2003–2004. In addition, we will examine the global risk of CHD in individuals with metabolic syndrome across sex, ethnicity, and age-groups and examine goal attainment and distance to recommended levels for key CHD risk factors.