Mid-Life Metabolic Syndrome Increases Heart Failure Risk at Older Age

The presence of metabolic syndrome in middle-aged men is associated with an increased risk for heart failure after 20 years. "Metabolic risk factors tend to cluster, and this cluster increases the risk for cardiovascular disease," Dr. Erik Ingelsson from Uppsala University, stated. "This is true, no matter which position you take in the ongoing debate regarding the definitions and use of the metabolic syndrome as a concept."

Dr. Ingelsson and colleagues investigated whether metabolic syndrome predicted later heart failure in some 2300 50-year-old men who were free from heart failure, prior acute myocardial infarction, and valvular disease in 1970-74. The men were followed up until the age of 70.

The risk for heart failure among participants with metabolic syndrome (5.3/1000 person years) was more than three times higher than that for subjects without metabolic syndrome (1.7/1000 person years), the researchers report.

Metabolic syndrome persisted as an independent predictor of heart failure after adjustment for established heart failure risk factors, the results indicate.

When myocardial infarction was included among the heart failure risk factors, metabolic syndrome was still associated with a 1.74-fold increased risk for heart failure, the researchers note.

"Metabolic syndrome can be considered as a clinical proxy for insulin resistance," Dr. Ingelsson said. "We have previously shown that insulin resistance is a strong risk factor for heart failure, independent of established risk factors, including obesity and diabetes. Therefore, the mechanisms behind the current findings surely include insulin resistance."

Dr. Ingelsson concluded: "As a doctor, you should urge your patients to decrease this risk by making lifestyle changes, such as diet modification, smoking cessation, and regular exercise."

Heart 2006;92:1409-1413.

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