Heart 2006 May 22; (Read article online)

Ingelsson E, Arnlöv J, Lind L, Sundström J

OBJECTIVE: The relation of the metabolic syndrome to incident heart failure (HF) is unknown. Thus, our aim was to explore the metabolic syndrome as a possible risk factor for development of HF. DESIGN: Community-based cohort study. SETTING: Uppsala, Sweden. PARTICIPANTS: We enrolled 2314 50-year-old men free from HF, myocardial infarction and valvular disease at baseline between 1970 and 1974, and they were followed until the age of 70. We used a modified National Cholesterol Education Program (NCEP) definition of the metabolic syndrome with body mass index in the place of waist circumference. MAIN OUTCOME MEASURE: First hospitalisation for heart failure. RESULTS: In multivariable Cox proportional hazards models adjusted for established risk factors for HF (hypertension, diabetes, electrocardiographic left ventricular hypertrophy, smoking and body mass index), the presence at baseline of the metabolic syndrome (hazard ratio, 1.66; 95% confidence interval, 1.02-2.70) was a predictor of subsequent HF. This relation was even stronger when adjusting for the presence of an acute myocardial infarction during follow-up in addition to the other established risk factors for CHF (hazard ratio 1.80, 95% confidence interval 1.11-2.91). CONCLUSION: The metabolic syndrome was a significant predictor of HF, independent of established risk factors for HF including an interim myocardial infarction, during two decades of follow-up in a community-based sample of middle-aged men. This implies that the metabolic syndrome provides important risk information beyond that carried by established risk factors for HF.