Gender differences in the prevalence and determinants of the metabolic syndrome in screened subjects at risk for coronary heart disease

Background: The metabolic syndrome is prevalent among individuals with coronary heart disease (CHD) risk factors. This study's goal was to compare gender differences in the prevalence and determinants of the metabolic syndrome in subjects who were re-examined after a cardiovascular risk factor screening program. Methods: In a population-based cross-sectional study of 14,811 screened men and women aged 30, 40, 45, and 59 to 60 years, 1,491 subjects in the predetermined risk categories of high glucose (n = 64, 69% male), cholesterol (n = 496, 66.3% male), and blood pressure (n = 362, 63.5% male) or Framingham risk score (n = 253, 93.7% male) or low HDL cholesterol (n = 316, 79.1% male) underwent further examination. Results: The metabolic syndrome was more prevalent among women than among men in the same risk categories with the exception of the blood pressure category. Women with the metabolic syndrome had a higher BMI and C reactive protein (CRP) levels, and were more likely to meet the waist circumference criterion than men (92% versus 70%; P < 0.0001). In multivariate analysis, BMI (odds ration(OR) 25.8, 95% CI 14.3-46.3 for >/=30 kg/m(2) versus < 25 kg/m(2)), CRP (OR 1.9, 95% CI 1.3-2.7 for the highest versus the lowest tertile) and female gender (OR 1.7, 95% CI 1.2-2.3 versus male) were associated with the metabolic syndrome after adjustment for age, physical activity, smoking, and family history of premature cardiovascular disease. Conclusion: The metabolic syndrome was more prevalent and more strongly characterized by obesity and low grade inflammation in women than men. These findings underscore the need to study gender-specific approaches to screen for CHD risk.