Metabolic syndrome and the risk of ischemic heart disease and stroke among Japanese men and women.
OBJECTIVE
Limited evidence was available on the metabolic syndrome and risk of cardiovascular disease in Asia. The purpose of this study is to examine the association of the metabolic syndrome and risk of ischemic cardiovascular disease in Japanese men and women.


METHODS
We conducted an 18-year prospective study of 9087 Japanese people aged 40 to 69 years (3595 men and 5492 women), initially free of ischemic heart disease or stroke. During follow-up, there were 116 (74 men and 42 women) cases of ischemic heart disease and 256 (144 men and 112 women) ischemic strokes. Metabolic syndrome was defined by the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII), with the presence of >/=3 of the following factors: (1) serum triglycerides >/=1.69 mmol/L (150 mg/dL); (2) HDL-cholesterol <1.03 mmol/L (40 mg/dL) for men and <1.29 mmol/L (50 mg/dL) for women; (3) glucose >/=6.11 mmol/L (110 mg/dL) fasting or >/=7.77 mmol/L (140 mg/dL) nonfasting, or on treatment; (4) blood pressure > or =130/85 mm Hg or medication use, and (5) body mass index >/=25.0 kg/m(2).


RESULTS
For both sexes, high blood pressure, high triglycerides and low HDL cholesterol were associated with increased risks of ischemic heart disease or stroke after adjustment for cardiovascular risk factors. A dose-response relationship was found between the number of metabolic risk factors and incidence of these cardiovascular end points. The multivariable hazard ratio (95% CI) associated with metabolic syndrome was 2.4 (1.4 to 4.0) in men and 2.3 (1.2 to 4.3) in women for ischemic heart disease, and 2.0 (1.3 to 3.1) and 1.5 (1.0 to 2.3), respectively, for ischemic stroke. The contribution of metabolic syndrome to the risks was independent of serum total cholesterol levels but stronger among smokers.


CONCLUSIONS
The metabolic syndrome is a major determinant of ischemic cardiovascular disease among middle-aged Japanese men and women, in particular among smokers.
Iso
Hiroyasu
H
Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Yamadaoka, Suita, Osaka-fu, Japan. iso@pbhel.med.osaka-u.ac.jp
Sato
Shinichi
S
Kitamura
Akihiko
A
Imano
Hironori
H
Kiyama
Masahiko
M
Yamagishi
Kazumasa
K
Cui
Renzhe
R
Tanigawa
Takeshi
T
Shimamoto
Takashi
T
D000328:Adult; D000368:Aged; D044466:Asian People; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology