Nutritionist calculating body mass index of woman for obesity treatment in a clinic room. Current research shows the gut microbiome may also influence risk for obesity.
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Middle-aged adults with three or more unhealthy traits, including slightly high waist circumference, or high blood pressure, cholesterol or glucose have heart attacks and strokes two years earlier on average than their peers, according to research presented today at this year’s European Society of Cardiology (ESC) Congress.

“Many people in their 40s and 50s have a bit of fat around the middle and marginally elevated blood pressure, cholesterol or glucose but feel generally well, are unaware of the risks and do not seek medical advice,” said study author Lena Lönnberg, PhD, of Västmanland County Hospital, Västerås, Sweden.

She added, “This scenario, called metabolic syndrome, is a growing problem in Western populations where people are unknowingly storing up problems for later in life. This is a huge missed opportunity to intervene before heart attacks and strokes that could have been avoided occur.”

It is estimated that up to 31% of the world’s population has metabolic syndrome, which puts people at higher risk of diabetes, heart disease, stroke, and premature death. This study investigated the link between asymptomatic metabolic syndrome in midlife and cardiovascular disease and death up to three decades later.

The study enrolled 34,269 adults in their 40s and 50s who attended a cardiovascular screening program in 1990 to 1999 in Västmanland. Participants went to their primary health care center for a clinical examination by a nurse, which included measurements of height, weight, blood pressure, total cholesterol, blood glucose, and waist and hip circumference. They also completed a questionnaire about lifestyle habits, previous history of cardiovascular disease and diabetes, and socioeconomic factors, such as education.

Individuals were classified as having metabolic syndrome if they had three or more of the following: 1) waist circumference of 102 cm or above for men and 88 cm or above for women, 2) total cholesterol 6.1 mmol/l or above, 3) 130 mmHg or higher systolic blood pressure and/or 85 mm Hg or higher diastolic blood pressure, 4) fasting plasma glucose 5.6 mmol/l or higher.

Participants with metabolic syndrome were matched with controls. Data on cardiovascular events (myocardial infarction and stroke) and death were collected from national and local registers.

A total of 5,084 individuals (15%) met the criteria for metabolic syndrome and there was a control group of 10,168 individuals. About 47% of participants were women. During a median follow-up of 27 years, 1,317 (26%) participants with metabolic syndrome died compared with 1,904 (19%) controls—making them 30% more likely to die during follow-up than their counterparts without metabolic syndrome.

Non-fatal cardiovascular events (myocardial infarction and/or stroke) occurred in 1,645 (32%) participants with metabolic syndrome and 2,321 (22%) controls—corresponding to a 35% greater risk of heart attack and stroke in the metabolic syndrome group. The median time to the first non-fatal heart attack or stroke was 16.8 years in the metabolic syndrome group and 19.1 years in the control group—a 2.3-year difference.

Lönnberg said: “As metabolic syndrome is a cluster of risk factors, the level of each individual component does not have to be severely raised. In fact, most people live with slightly raised levels for many years before having symptoms that lead them to seek health care.”

She concluded, “The results underline the importance of early detection of risk factors through health screening programs so that preventive actions can be taken to prevent heart attack, stroke and premature death. As a general rule of thumb, even if you feel well, check your blood pressure every year, avoid smoking, keep an eye on your waist circumference and last, but definitely not least, be physically active every day.”

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