ATLANTA — The majority of the estimated 40 million Americans with the metabolic syndrome are at very low or low calculated 10-year risk for coronary heart disease, Dr. Khiet Hoang reported at the annual meeting of the American College of Cardiology.
On the other hand, more than half of all men with the metabolic syndrome are at intermediate or high risk for CHD, as is also true for African Americans, both male and female, according to Dr. Hoang of the Heart Disease Prevention Program at the University of California, Irvine.
These findings underscore the wide spectrum of cardiovascular risk encompassed by the term metabolic syndrome. And that, in turn, reinforces the importance of individualized formal global risk assessment of patients with metabolic syndrome in order to more appropriately target intensity of treatment, the physician added.
Dr. Hoang and coworkers estimated the prevalence of metabolic syndrome by applying the National Cholesterol Education Program criteria to adults aged 20–79 in the National Health and Nutrition Examination Survey database for 2001–2002. They then applied the Framingham risk algorithms to calculate 10-year CHD risk in individuals with metabolic syndrome. Patients with diabetes or preexisting CHD were automatically classified as high risk.
The prevalence of the metabolic syndrome was 27.5% in men and 28.6% among women. Of individuals with the syndrome, 15% were at intermediate CHD risk (their 10-year calculated risk was 10%–20%) and 41% were at very low risk (their 10-year risk was less than 6%).
Fully one-third of all persons with the metabolic syndrome were deemed at high risk for a future CHD event, meaning their 10-year risk exceeded 20%. A particularly striking finding was that roughly 90% of these individuals were high risk by virtue of having diabetes or preexisting CHD; only 3.1% of all adults with metabolic syndrome were high risk on the basis of a calculated Framingham 10-year risk greater than 20%.
The proportion of individuals with metabolic syndrome at high CHD risk was 47% among African Americans, 32% in Hispanics, and 31% in whites.