Metabolic syndrome (MetS) is defined by a group of markers including elevated blood pressure, increased fasting blood glucose and dyslipidemia along with increased levels of adiposity, particularly central fat deposition.  It is estimated that MetS affects 1 in 3 Americans with a higher prevalence in women than in men.  MetS is a launching point for other chronic disease processes as well due to its relationship to increased inflammation and obesity – these processes include non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD).  Less well understood is MetS’s role in sudden cardiac death.  Up to 350,000 deaths annually in the United States are caused by sudden cardiac death with a disproportionate number of black males affected.

A longitudinal population-based sample of 13,168 individuals were followed for a median of 23.6 years to better understand the relationship between the presence of MetS and its possible association with sudden cardiac death and, if positive, whether the association was more prevalent in a particular sex or race (only black and white individuals were enrolled in this study).

Participants in this study were drawn from four US Communities including Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and the northwestern suburbs of Minneapolis, Minnesota.  Individuals must have been free from any form of cardiovascular disease at the time of enrollment.  Follow up examinations were conducted on average every 3 years for the first decade and long term follow up after this time period was conducted through annual telephone interviews and active surveillance of community hospitals associated with the study.

Several main take away points became clear at the conclusion of this time period:

  1. This study showed that MetS was associated with an approximate 70% increased risk of sudden cardiac death
  2. This relationship did not change based on sex or race
  3. The higher the number of MetS components present, the higher the risk of sudden cardiac death
  4. Blood pressure, impaired fasting glucose and low HDL were the MetS components most important to increasing sudden cardiac death risk

Increased awareness on the relationship between MetS and sudden cardiac death is an important aspect of wellness visits to a healthcare provider and increased education should be offered for those with these risk factors.

Why is the Clinically Relevant?

  • HCPs should screen for and actively treat MetS markers, particularly elevated blood pressure, impaired fasting glucose and low HDL
  • Lifestyle medicine should be implemented as first line therapy for reducing risk of MetS and subsequently risk for sudden cardiac death
  • Males and females from both black and white races have a similar risk of sudden cardiac death if MetS components are present
  • The risk of sudden cardiac death is proportional to the number of MetS components present


Link to Abstract


Hess PL, et al.  The Metabolic Syndrome and Risk of Sudden Cardiac Death:  the Atherosclerosis Risk in Communities Study.  J Am Heart Assoc. 2017;6:e006 103. DOI: 10.1161/JAHA.117.006 103.

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