Metabolic syndrome and ischemic heart disease in elderly men and women

Associations between metabolic syndrome components and prevalent ischemic h eart disease (IHD) were investigated in a cross-sectional, community-based study of elderly men (n = 1,015) and women (n = 1,259) in Rancho Bernardo, California, in 1984-1987. In both sexes, there were significant positive as sociations between IHD defined by resting electrocardiogram criteria and ag e, systolic blood pressure, fasting and postchallenge hyperglycemia, total cholesterol/high density lipoprotein cholesterol (HDL cholesterol) ratio, a nd triglycerides and an inverse significant association with HDL cholestero l. High collinearity and interactions between serum insulin and metabolic s yndrome variables were accounted for by uncorrelated principal components i dentified by factor analysis. In both men and women, three uncorrelated pri ncipal components were identified, representing a central metabolic factor (body mass index, fasting and 2-hour serum insulin, high serum triglyceride s, and low HDL cholesterol), a glucose factor, and a blood pressure factor. In a multivariate model with age and sex, all three factors were significa ntly associated with IHD by electrocardiogram criteria; central metabolic f actor (odds ratio (OR) = 1.6, p = 0.001), glucose factor (OR = 1.4, p < 0.0 01), blood pressure factor (OR = 1.2, p = 0.005), age (10 years) (OR = 1.8, p < 0.001), and female sex (OR = 0.5, p < 0.02). Similar results were obta ined in analyses using clinically manifest IHD as the outcome. These result s support the thesis that the metabolic syndrome exerts effects through dif ferent risk factors by different mechanisms.