The Association Between Metabolic Syndrome and Heart Failure in Middle-aged Men and Women : Population-Based Study of 2 Million Individuals

Background: Although the association between metabolic syndrome (MetS) and heart failure (HF) risk is known, large longitudinal studies that can permit causal inferences are limited. In this study, we investigated metabolic status as a risk factor for HF in middle-aged men and women and evaluated sex differences in various risk factors for HF using nationwide real-world data.Methods: Data obtained from the Korean National Health Insurance Service from 2009 to 2016 were analyzed. A total of 2151597 middle-age subjects (1149642 men and 1001955 women) (between 50 and 59 years old) without a history of Cardiovascular or cerebrovascular disease or malignancy were enrolled. Subjects were divided into three groups according to the number of MetS components: 0 (normal), 1–2 (Pre‐MetS) or 3–5 (MetS) based on the National Cholesterol Education Program Adult Treatment Panel III criteria. Cox proportional hazard models were used to estimate the association between MetS and incident HF after adjusting for clinical risk factors.Results: At baseline, MetS existed in 23,77% of men and 10.58% of women. Pre-MetS and MetS increased the risk of HF: the hazard ratio (95% confidence interval) of pre-MetS was 1.508 (1.287-1.767) in men and 1.395 (1.158-1.681) in women; the hazard ratio (95% confidence interval) of MetS was 1.711 (1.433-2.044) in men and 2.144 (1.674-2.747) in women. Current smoking, low hemoglobin level, underweight (BMI<18.5) and high creatinine level as well as acute myocardial infarction were also predictors of HF in both men and women.Conclusions: This study confirmed that pre-MetS and MetS are risk factors for HF in middle-aged men and women. The effect of MetS on the occurrence of HF was stronger in women than in men. Pre-MetS was also a predictor of HF but was associated with a lower risk than MetS.