The metabolic syndrome and risk of myocardial infarction in familial hypertension (Hypertension Heredity in Malmö Evaluation study).

J Hypertens. 2009 Jan;27(1):109-17. Fedorowski A, Burri P, Hulthén L, Melander O. aDepartment of Medicine, Sweden bDepartment of Clinical Sciences, Lund University, Sweden cDepartment of Endocrinology, Malmö University Hospital, Malmö, Sweden.

OBJECTIVES: The aim of this study was to examine whether three main definitions of the metabolic syndrome (MetS) - WHO, National Cholesterol Education Program-Adult Treatment Panel III and International Diabetes Federation - identify the same individuals and are able to predict incident myocardial infarction (MI) in families with essential hypertension.

METHODS: The tested definitions were prospectively related to data on MI in a cohort of approximately 1700 individuals with overt essential hypertension and their normotensive first-degree relatives.

RESULTS: At baseline, 616 participants had MetS, yet only 209 of them (33.9%) were identified by all definitions, and compatibility rate for each pair of definitions was approximately 50%. During follow-up (Tmean approximately 6.6 years) 53 participants developed MI and they were generally older and more dysmetabolic than the rest of the cohort. There were also more men, smokers and diabetic individuals in this group. After adjustment for all conventional cardiovascular risk factors, including hypertension and diabetes, only the National Cholesterol Education Program definition could predict the increased risk of MI [odds ratio (OR) = 2.2, confidence interval (CI) = 1.2-4.0, P = 0.01]. Among individual MetS components, incident MI was independently associated with three of them: low high-density lipoprotein-cholesterol (OR = 2.03, CI = 1.09-3.78, P = 0.025) insulin resistance (OR = 2.02, CI = 1.08-3.78, P = 0.028) and increased albumin excretion rate (OR = 1.24, CI = 0.99-1.55, P = 0.060).

CONCLUSION: The presence of MetS in hypertensive and genetically hypertension prone individuals may signal the increased risk of future MI. However, only the National Cholesterol Education Program criteria appear to have a sufficient predictive accuracy.

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