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QUARTERLY FOCUS ISSUE: HEART RHYTHM DISORDER: CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION

Metabolic Syndrome and Risk of Acute Myocardial Infarction

A Case-Control Study of 26,903 Subjects From 52 Countries

Andrew Mente, PhD^_*,, Salim Yusuf, MBBS, DPhil^_*,, Shofiqul Islam, MS^_*, Matthew J. McQueen, MBChB, PhD^_*,, Supachai Tanomsup, MD, Churchill L. Onen, MD^||, Sumathy Rangarajan, MS^_*, Hertzel C. Gerstein, MD, MS^_*,, Sonia S. Anand, MD, PhD^_*,,_* for the INTERHEART Investigators

^_* Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
Division of Cardiology, Ramathibodi Hospital, Bangkok, Thailand
^|| Center for Chronic Diseases, Gaborone Private Hospital, Gaborone, Botswana

Manuscript received September 28, 2009; revised manuscript received December 14, 2009, accepted December 17, 2009.

^_* Reprint requests and correspondence: Dr. Sonia S. Anand, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton General Hospital Campus, 237 Barton Street East, Room C3-102, Hamilton, Ontario L8L 2X2, Canada (Email: anands{at}mcmaster.ca).

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.

Key Words: myocardial infarction • metabolic syndrome • diabetes mellitus • ethnicity • epidemiology

Abbreviations and Acronyms   Apo = apolipoprotein   CI = confidence interval   Hb = hemoglobin   HDL = high-density lipoprotein   IDF = International Diabetes Federation   MI = myocardial infarction   MS = metabolic syndrome   OR = odds ratio   PAR = population attributable risk   WHO = World Health Organization

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