A group of unhealthy traits has been linked to earlier heart attacks and strokes

The link between asymptomatic metabolic syndrome in middle age and cardiovascular disease.


Metabolic syndrome is a growing problem in Western populations. People unknowingly store problems for later in life, leading to missed opportunities to intervene before heart attacks and strokes could have been avoided. Up to 31% of the world’s population is estimated to suffer from metabolic syndrome.

Research presented at the European Society of Cardiology (ESC) Congress 2021 has found that middle-aged adults with three or more unhealthy traits, including slightly high waist circumference, blood pressure, cholesterol, and glucose, have heart attacks and strokes two years earlier than their peers. 

Study author Dr. Lena Lönnberg of Västmanland County Hospital, Västerås, Sweden, said, “Many people in their 40s and 50s have a bit of fat around the middle and marginally elevated blood pressure, cholesterol or glucose but generally feel well, are unaware of the risks and do not seek medical advice.” 

The study examined the relationship between asymptomatic metabolic syndrome in middle age and cardiovascular disease and death up to three decades later.

The Research included 34,269 adults between their 40s and 50s who participated in a cardiovascular screening program in the Swedish county of Västmanland from 1990 to 1999. Participants attended their primary health care center for a medical examination by a nurse, including height, weight, blood pressure, total cholesterol, blood glucose, and waist and hip circumference measures. They also completed a questionnaire regarding their lifestyle habits, a family history of cardiovascular disease and diabetes, and socioeconomic characteristics like education.

Individuals were classified with metabolic syndrome if they had three or more of the following symptoms:

  1. A waist circumference of 102 cm or greater for males and 88 cm or more significant for women
  2. Total cholesterol of 6.1 mmol/l or greater
  3. Systolic blood pressure of 130 mmHg or greater and diastolic blood pressure of 85 mmHg or greater
  4. Fasting plasma glucose of 5.6 mmol/l or higher

Participants with metabolic syndrome were matched to two persons without metabolic syndrome who acted as controls regarding age, gender, and date of health examination. National and local registers collected information on cardiovascular events (myocardial infarction and stroke) and deaths. The researchers analyzed the links between midlife metabolic syndrome and nonfatal cardiovascular events and all-cause mortality after controlling for age, gender, smoking, physical inactivity, education level, body mass index, hip circumference, and living alone or with family.

A total of 5,084 individuals (15%) met the criteria for metabolic syndrome, and a control group of 10,168 individuals without metabolic syndrome was identified. Some 47% of participants were women. During a median follow-up of 27 years, 1,317 (26%) participants with metabolic syndrome died compared with 1,904 (19%) controls, meaning that those with metabolic syndrome were 30% more likely to die during follow-up than their counterparts without metabolic syndrome.

Nonfatal cardiovascular events (myocardial infarction and stroke) occurred in 1,645 (32%) of the people with metabolic syndrome and 2,321 (22%) of the controls, resulting in a 35% increased risk of heart attack and stroke in the metabolic syndrome group. The median time to the first nonfatal heart attack or stroke in the metabolic syndrome group was 16.8 years against 19.1 years in the control group, a 2.3-year difference.

She said, “As metabolic syndrome is a cluster of risk factors, the level of each component does not have to be severely raised. Most people live with slightly raised levels for many years before having symptoms that lead them to seek health care. In our study, middle-aged adults with metabolic syndrome had a heart attack or stroke 2.3 years earlier than those without the collection of unhealthy traits. Blood pressure was the riskiest component, particularly for women in their 40s, highlighting the value of keeping it under control.”

In conclusion, the findings highlight the importance of early detection of risk factors through health screening programs to take preventive actions to prevent heart attacks, strokes, and premature deaths. Even if you feel well, check your blood pressure once a year, avoid smoking, keep an eye on your waist circumference, and, last but not least, stay physically active every day.

The Regional Board funded the study for the County of Västmanland and the Centre for Clinical Research.

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