Clustering of metabolic factors and coronary heart disease

Background: The degree of clustering for common metabolic coronary disease risk factors is not well known, the antecedents of clustering are not well studied, and the impact of such clusters on coronary risk has not been asse ssed systematically. Methods: Prospective community sample of 2406 men and 2569 women aged 18 to 74 years at baseline. The 6 metabolically linked risk factors considered w ere the lowest sex-specific quintile of high-density lipoprotein cholestero l and the highest quintiles of body mass index, systolic blood pressure, tr iglycerides, glucose, and serum total cholesterol. Results: At baseline the risk factor sum, represented as integer values, ra nged from 0 to 6, and clusters of 3 or more risk factors occurred at twice the rate predicted by chance. After adjustment for age and obesity level, a 2.25-kg (5-lb) weight increase over 16 years was associated with an increa sed risk factor sum in men (+20%; P = .002) and women (+37%; P<.001), and a 2.25-kg weight loss was associated with a decreased risk factor sum in men (-48%; P<.001) and women (-40%; P<.001). Clusters of 3 or more risk factor s were associated with a 2.39 (95% confidence interval, 1.56-3.36) and 5.90 (95% confidence interval, 2.54-13.73) times greater risk of coronary heart disease in men and women, respectively (both P<.001). Conclusions: Atherogenic risk factor clustering is common in both sexes, wo rsens with weight gain, and is associated with greatly increased risk of co ronary disease risk in both sexes.