• The authors of this study determined whether there is an association between metabolic syndrome and sudden cardiac death among 13,168 participants of the Atherosclerosis Risk in Communities study free of prevalent coronary heart disease or heart failure. During a median follow-up of 23.6 years, participants with metabolic syndrome had a significantly greater rate of sudden cardiac death compared with those without (4.1% vs 2.3%; P < .001). Metabolic syndrome was independently associated with sudden cardiac death after adjusting for participant demographics and clinical factors other than components of the metabolic syndrome. This relationship was not influenced by gender or race. Of the components of metabolic syndrome, elevated blood pressure, impaired fasting glucose, and low-density lipoprotein were independently associated with sudden cardiac death.
• The risk of sudden cardiac death increased in patients with metabolic syndrome regardless of gender or race and was proportional to the number of metabolic syndrome components.

Abstract

BACKGROUND

Prior studies have demonstrated a link between the metabolic syndrome and increased risk of cardiovascular mortality. Whether the metabolic syndrome is associated with sudden cardiac death is uncertain.

METHODS AND RESULTS

We characterized the relationship between sudden cardiac death and metabolic syndrome status among participants of the ARIC (Atherosclerosis Risk in Communities) Study (1987-2012) free of prevalent coronary heart disease or heart failure. Among 13 168 participants, 357 (2.7%) sudden cardiac deaths occurred during a median follow-up of 23.6 years. Participants with the metabolic syndrome (n=4444) had a higher cumulative incidence of sudden cardiac death than those without it (n=8724) (4.1% versus 2.3%, P<0.001). After adjustment for participant demographics and clinical factors other than components of the metabolic syndrome, the metabolic syndrome was independently associated with sudden cardiac death (hazard ratio, 1.70, 95% confidence interval, 1.37-2.12, P<0.001). This relationship was not modified by sex (interaction P=0.10) or race (interaction P=0.62) and was mediated by the metabolic syndrome criteria components. The risk of sudden cardiac death varied according to the number of metabolic syndrome components (hazard ratio 1.31 per additional component of the metabolic syndrome, 95% confidence interval, 1.19-1.44, P<0.001). Of the 5 components, elevated blood pressure, impaired fasting glucose, and low high-density lipoprotein were independently associated with sudden cardiac death.

CONCLUSIONS

We observed that the metabolic syndrome was associated with a significantly increased risk of sudden cardiac death irrespective of sex or race. The risk of sudden cardiac death was proportional to the number of metabolic syndrome components.

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