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Multiethnic Study Identifies Factors That Predispose Midlife Women to Cardiometabolic Risk

David Bai, PharmD
Modifiable factors, including lower caloric intake, greater physical activity, and smoking cessation, have been associated with recovery from metabolic syndrome, according to the results recently published following a multiethnic study.
Modifiable factors, including lower caloric intake, greater physical activity, and smoking cessation, have been associated with recovery from metabolic syndrome, according to the results from a multiethnic study by Ward et al.

Metabolic syndrome is defined as a multifactorial condition that increases the risk of developing type 2 diabetes or cardiovascular disease. According to the American Heart Association, classification of metabolic syndrome requires at least 3 of 5 cardiometabolic risk components: high fasting triglyceride (TG) level (≥150 mg/dL), low high-density lipoprotein (HDL) cholesterol (<50 mg/dL), elevated fasting plasma glucose (≥100 mg/dL or on antihyperglycemic medications), large waist circumference (>88 cm or >80 cm for Japanese or Chinese women), and hypertension (HTN; systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg or on antihypertensive medication). Currently, the incidence rates of metabolic syndrome for midlife women of different races are not known. In a study by Ward et al, midlife women are characterized to identify risk factors in relation to metabolic syndrome.

In this study, 3003 midlife women who are white, black, Japanese, Hispanic, and Chinese, participated and were subclassified as:
  • Never having metabolic syndrome
  • Having metabolic syndrome
  • Developing metabolic syndrome during follow-up
  • Having metabolic syndrome at baseline and then not having metabolic syndrome for at least 2 consecutive follow-ups.
Women were also identified according to smoking history, alcohol intake, physical activity, and caloric intake.

Upon analysis of the entire study population, investigators found that 31% had no metabolic syndrome components, 25% had 1 component, and 18% had 2 components at baseline. Japanese and Chinese women had the highest proportions with no components, although black and Hispanic women had higher proportions with at least 2 components. With all races, large waist circumference and low HDL had the greatest incidences, except black women were HTN had greater incidence than low HDL. Among women with pre-existing metabolic syndrome, 47% had only 3 components, 31% had 4 components, and 12% had 5 components. Having a large waist circumference, low HDL, and high TG was a frequent combination observed.

Women who developed metabolic syndrome at follow-up had the greatest incidence of large waist circumference, low HDL, and high TG. Changes reflecting the different races were seen, with black women having a higher prevalence of HTN and high glucose. Hispanic women also had higher incidence of HTN, although Chinese, Japanese, and white women predominated in large waist circumference, low HDL and high TG. However, large waist circumference remained the most frequent component in all races (86%).

At the last follow-up, 74% of the women with metabolic syndrome at baseline still had metabolic syndrome at the last follow up. In the study, 67% of women without metabolic syndrome and zero or 1 components kept the same number of components. Meanwhile, 32% of women with 2 components at baseline developed metabolic syndrome. Women with high glucose levels were more likely to recover to no components (66%), although women with high triglyceride levels were more likely to progress to metabolic syndrome. Low HDL was the most commonly lost component, and large waist circumference was the least. Hispanic and black women had higher incidences of developing MetS, although Chinese and Japanese women had the least incidences. Physical activity was associated with a 60% decreased risk, although hormonal therapy and smoking increased risks.

From this study, a lot of valuable data was extracted on finding key risk factors and characteristics for midlife women. Although this study helps identify many of the risk factors, more information will be needed to see if these interventions help prevent or help women recover from MetS.


Ward E, Gold EB, Johnson WO, et al. Patterns of cardiometabolic health as midlife women transition to menopause: a prospective multi-ethnic study [published online October 25, 2018]. J Clin Endocrinol Metab. doi: 10.1210/jc.2018-00941.

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