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Metabolic Syndrome Increases Cardiovascular Risks

Presence of 2-3 metobolic factors resulted in greater risk for black women compared to white women…

An international team of American and Danish researchers identified 14,364 postmenopausal women from the Women’s Health Initiative who had data on fasting serum lipids and serum glucose and no history of cardiovascular disease or diabetes at baseline. They categorized women by body mass index (in kg/m2) as normal weight (body mass index 18.5 to <25), overweight (body mass index 25 to <30), or obese (body mass index ≥30) and by metabolic health, defined first as the metabolic syndrome (metabolically unhealthy: ≥3 metabolic abnormalities) and second as the number of metabolic abnormalities. The researchers used Cox proportional hazards regression to assess associations between baseline characteristics and cardiovascular risk.

Over 13 years of follow‐up, 1101 women had a first cardiovascular disease event (coronary heart disease or ischemic stroke). Among black women without metabolic syndrome, overweight women had higher adjusted cardiovascular risk than normal weight women (hazard ratio [HR] 1.49), whereas among white women without metabolic syndrome, overweight women had similar risk to normal weight women (HR 0.92, interaction P=0.05). Obese black women without metabolic syndrome had higher adjusted risk (HR 1.95) than obese white women (HR 1.07; interaction P=0.02). Among women with only 2 metabolic abnormalities, cardiovascular risk was increased in black women who were overweight (HR 1.77) or obese (HR 2.17) but not in white women who were overweight (HR 0.98) or obese (HR 1.06). Overweight and obese women with ≤1 metabolic abnormality did not have increased cardiovascular risk, regardless of race or ethnicity.

The researchers concluded that metabolic abnormalities appeared to convey more cardiovascular risk among black women.

 

Practice Pearls:

  • Previous studies have indicated that obesity without metabolic syndrome (defined here as having at least three of the risk factors) is not associated with an increase in cardiovascular disease risk. However, these studies focused predominantly on white participants.
  • The researchers found that, among black women with 2-3 metabolic risk factors, the relative risk of cardiovascular disease increased by 117% in those that were obese and increased by 77% in women who were overweight.
  • The findings imply that metabolic syndrome may underestimate cardiovascular disease risk in black women and overestimate it in white women.

Michelle D. Schmiegelow. Race and Ethnicity, Obesity, Metabolic Health, and Risk of Cardiovascular Disease in Postmenopausal Women. J Am Heart Assoc. 2015; 4: e001695. originally published May 20, 2015. doi: 10.1161/JAHA.114.001695