Metabolic Syndrome Found to be Greater Risk Factor for Heart Failure Than Obesity Alone

Contact: Amanda Jekowsky,, 202-375-6645

Adding further data to the ongoing discussion about how to best prevent heart failure (HF), a Greek research team found that normal-weight people with metabolic syndrome (MetS) had higher rates of HF than obese study subjects without MetS, according to a new study in the Journal of the American College of Cardiology (JACC).  The findings readdress the significance of MetS and insulin resistance as markers of future HF risk and highlight the importance of evaluating metabolic status in all cardiovascular risk stratification, regardless of weight.
For the study, researchers from Athens University Medical School enrolled 550 individuals without diabetes or baseline macrovascular disease between 2003 and 2005 and followed them across a 6-year period to determine the incidence of HF. Study participants were classified according to the presence (n = 271) or absence (n = 279) of MetS (as diagnosed through the National Cholesterol Education Program Adult Treatment Panel [NCEPATP] III criteria) and by body mass index (normal weight = 177, overweight = 234, obese = 139).  Left ventricular functional capacity, myocardial structure, and performance were also assessed, through echocardiographs.
The research team found that at the six-year follow-up point, HF had occurred in 185 of the 550 study participants. In addition, they found that metabolically healthy overweight and obese participants had a decreased HF risk compared to their normal-weight peers with MetS. Specifically, the presence of MetS conferred a 2.5-fold higher HF risk (hazard ratio [HR]: 2.5, 95% confidence interval [CI]: 1.68 to 3.40). Of the five components of MetS included in the NCEPATP criteria, four were individually associated with increased HF risk: impaired fasting glucose, low high-density lipoprotein cholesterol, high blood pressure, and central obesity. Insulin resistance and inflammation—factors commonly associated with MetS—were also independently associated with heart failure incidence. By contrast, the researchers did not find an independent risk association with BMI.
According to the researchers, the finding that “metabolically healthy” obese individuals had a lower risk of heart failure provides interesting information to ongoing research that is examining people who—despite their body fat—display a favorable metabolic profile. Lead researcher Christina Voulgari, MD, PhD, adds that a better understanding of how this “fat, but otherwise healthy” population is protected from HF “will eventually enable us to understand the pathophysiological pathways that predispose, delay, or protect individuals from future HF risk.” She noted, “It helps us give a possible answer to the contemporary question: you are slim, but is your heart fat?”


The American College of Cardiology is transforming cardiovascular care and improving heart health through continuous quality improvement, patient-centered care, payment innovation and professionalism. The College is a 39,000-member nonprofit medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice managers, and bestows credentials upon cardiovascular specialists who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online at

< Back to Listings