Published Online
on April 12, 2007

A more recent version of this article appeared on June 1, 2007

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Submitted on August 24, 2006
Revised on November 12, 2006
Accepted on November 15, 2006

Metabolic Syndrome and the Risk of Ischemic Heart Disease and Stroke Among Japanese Men and Women

Hiroyasu Iso MD^*; Shinichi Sato MD; Akihiko Kitamura MD; Hironori Imano MD; Masahiko Kiyama MD; Kazumasa Yamagishi MD; Renzhe Cui MD; Takeshi Tanigawa MD; and Takashi Shimamoto MD

From Public Health (H. Iso), Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka-fu, Japan; The Osaka Medical Center for Health Science and Promotion (S.S., A.K., H. Imano, M.K.), Osaka, Japan; Department of Public Health Medicine (K.Y., R.C., T.T.), Majors of Social and Environmental Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba-shi, Ibaraki-ken, Japan.

^* To whom correspondence should be addressed. E-mail: iso{at}pbhel.med.osaka-u.ac.jp.

Background and Purpose--Limited evidence was available on the metabolic syndrome and risk of cardiovascular disease in Asia. The purpose of this study is to examine the association of the metabolic syndrome and risk of ischemic cardiovascular disease in Japanese men and women.

Methods--We conducted an 18-year prospective study of 9087 Japanese people aged 40 to 69 years (3595 men and 5492 women), initially free of ischemic heart disease or stroke. During follow-up, there were 116 (74 men and 42 women) cases of ischemic heart disease and 256 (144 men and 112 women) ischemic strokes. Metabolic syndrome was defined by the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII), with the presence of 3 of the following factors: (1) serum triglycerides 1.69 mmol/L (150 mg/dL); (2) HDL-cholesterol <1.03 mmol/L (40 mg/dL) for men and <1.29 mmol/L (50 mg/dL) for women; (3) glucose 6.11 mmol/L (110 mg/dL) fasting or 11.1 mmol/L (140 mg/dL) nonfasting, or on treatment; (4) blood pressure 130/85 mm Hg or medication use, and (5) body mass index 25.0 kg/m².

Results--For both sexes, high blood pressure, high triglycerides and low HDL cholesterol were associated with increased risks of ischemic heart disease or stroke after adjustment for cardiovascular risk factors. A dose-response relationship was found between the number of metabolic risk factors and incidence of these cardiovascular end points. The multivariable hazard ratio (95% CI) associated with metabolic syndrome was 2.4 (1.4% to 4.0%) in men and 2.3 (1.2% to 4.3%) in women for ischemic heart disease, and 2.0 (1.3% to 3.1%) and 1.5 (1.0% to 2.3%), respectively, for ischemic stroke. The contribution of metabolic syndrome to the risks was independent of serum total cholesterol levels but stronger among smokers.

Conclusions--The metabolic syndrome is a major determinant of ischemic cardiovascular disease among middle-aged Japanese men and women, in particular among smokers.

Key words: follow-up studies • ischemic heart disease • ischemic stroke • metabolic syndrome • risk factors

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