A high risk score for coronary heart disease is associated with the metabolic syndrome in 40-year-old men and women.J Cardiovasc Risk 2003; 10(2):129-35JC
Guidelines recommend follow-up of people whose 10-year risk of coronary heart disease (CHD) is > 10%. We calculated CHD risk, number of risk factors and occurrence of the metabolic syndrome among screened 40-year-old men and women.
A total of 1547 women and 1374 men participated in a cardiovascular risk factor screening programme in 1997-1999 in Oslo. Of 387 (13%) recalled for further examination and advice, 337 (87%) attended. We used the National Cholesterol Education Program criteria to define the metabolic syndrome and the Framingham risk score to assess absolute 10-year risk of CHD and counted nine risk factors (male, southeast-Asian origin, low education, smoking, premature familial cardiovascular disease (CVD), hypertension, high waist circumference, impaired fasting glucose or diabetes and high apolipoprotein B).
More than one-third of subjects recalled for hypertension (n = 88) or low high-density lipoprotein (HDL) cholesterol (n = 95) had the metabolic syndrome. Of 55 subjects with a 10-year risk score > 10%, 33 (60%) had the metabolic syndrome. Subjects with the metabolic syndrome had a higher risk score compared with their counterparts (P < 0.001); among men with the metabolic syndrome, the mean +/- SD risk score was 10.0 +/- 4.4%. Subjects with dyslipidaemia [high triglyceride and normal low-density lipoprotein (LDL) cholesterol levels] or combined hyperlipidaemia had a higher risk score and more risk factors compared with subjects with isolated high LDL cholesterol (P < 0.05). Only 12% of subjects with hypertension were taking drugs and of 237 subjects with a lipid disorder, 30% had been given dietary advice and one was taking a lipid-lowering drug.
CVD screening should focus on identifying people with features of the metabolic syndrome in this age group. The screening programme uncovered a substantial potential for CVD prevention.