Heart’s Recovery After Metabolic Syndrome May Take Years

Shedding the metabolic syndrome improves, but doesn’t erase, excess risk of major adverse cardiovascular events (MACE), a Korean study showed.

The biggest impact came from resolving hypertension, Dong Ki Kim, MD, PhD, of Seoul National University College of Medicine, and colleagues reported in the Annals of Internal Medicine.

Compared with chronic metabolic syndrome, those who no longer had at least three of the five characteristic components — central obesity, high triglycerides, low HDL, glucose intolerance, and hypertension (or treatment thereof) — had a significant 15% lower adjusted incidence of MACE (4.55 vs 8.52 per 1,000 person-years) at a median follow-up of 3.54 years.

However, even the metabolic syndrome-recovered group remained at higher risk of the composite of acute MI, revascularization, and acute ischemic stroke than those who never had metabolic syndrome after adjustment for age, sex, low income, baseline kidney function, and hemoglobin and liver enzyme levels (incidence rate ratio 1.19, 95% CI 1.16-1.22).

Complete reversal of the consequences of having had metabolic syndrome for a period of time could take longer, Kim’s group speculated.

As expected, new onset of metabolic syndrome raised that risk 36% compared with remaining free of it (6.05 vs 1.92 MACE per 1,000 person-years).

“Although the findings can be explained by traditional concepts of controlling metabolic risk factors to reduce MACE risk, such nationwide results provide unique evidence supporting the benefits of MetS [metabolic syndrome] recovery and prevention,” the researchers noted.

They studied individuals who received national health screenings offered free every year or 2 (70% of the population usually participates) during the study period from 2009 to 2014 and who had no prior MACE or impaired kidney function.

Administrative data yielded 9.55 million adults age 20 and older who had at least three screens during the study period:

• 16% who had metabolic syndrome at all three screens
• 6% without it on the first screen but with it on the subsequent two screens
• 6% who had it on the first screen but not the subsequent two
• 73% free from metabolic syndrome at all three screens

Limitations of the study included possible residual confounding, use of administrative codes rather than directly adjudicated outcomes, and consideration of only a single country’s population with a relatively low prevalence of obesity and metabolic syndrome (U.S. prevalence was 33% in 2012).

Even so, they concluded, “Our study encourages health care providers to pay attention to a history of MetS even in persons who are currently free from MetS.”

last updated 11.26.2019