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Middle-aged men with metabolic syndrome at increased risk for major CV events, despite BMI status

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Metabolic syndrome increased the risk for cardiovascular events and total death — despite BMI status — during 30 years of follow-up in middle-aged, overweight or obese men.

In a new study, researchers assessed the associations between seven BMI categories and metabolic syndrome and risk for CV disease and death. The study population included 1,758 men living in Sweden who participated in the community-based Uppsala Longitudinal Study of Adult Men.

Men were separated into the following BMI categories:

• Normal weight (BMI <25) without metabolic syndrome (n=891).
• Normal weight with metabolic syndrome (n=64).
• Overweight (BMI 25 to 30) without metabolic syndrome (n=582).
• Overweight with metabolic syndrome (n=125).
• Obese (BMI >30) without metabolic syndrome (n=30).
• Obese with metabolic syndrome (n=66).

As a secondary aim, researchers assessed the association between combinations of BMI levels and the presence or absence of insulin resistance with future risk for cardiovascular disease or death.

Cardiovascular disease and death

During follow-up, 681 participants developed CVD; 845 died, and 386 of the deaths were associated with CVD.

When compared with normal-weight participants without metabolic syndrome, researchers found an increased risk for CVD among normal-weight participants with metabolic syndrome (HR=1.63; 95% CI, 1.11 to 2.37), overweight with and without metabolic syndrome (HR=1.74; 95% CI, 1.32 to 2.30 and HR=1.52; 95% CI, 1.28 to 1.80) and obese with and without metabolic syndrome (HR=2.55; 95% CI, 1.81 to 3.58 and HR=1.95; 95% CI, 1.14 to 3.34).

Despite the presence or absence of metabolic syndrome, obesity was associated with an increased risk for non-CV death (HR=1.94, 95% CI, 1.23 to 3.6 and HR=1.91; 95% CI, 1.24 to 2.94) and cancer incidence (HR=1.72; 95% CI, 1.10 to 2.70 and HR=1.82; 95% CI, 1.04 to 3.20) when compared with normal-weight participants without metabolic syndrome.

“The present data refute the notion that overweight and obesity without metabolic syndrome are benign conditions,” the researchers concluded.

Arnlov J. Circulation. 2010;121:230-236.