Association between metabolic syndrome and risk of cardiovascular disease among postmenopausal women: A cohort study

Abstract Aim Cardiovascular disease is the leading cause of death among women worldwide. Metabolic syndrome is more prevalent after menopause. The decline in estrogen during this transition promotes adverse metabolic and vascular changes, substantially elevating cardiovascular risk. However, evidence on the impact of metabolic syndrome on cardiovascular risk in postmenopausal women remains limited. Materials and Methods This study utilized data from the Kailuan cohort, which initially enrolled 32959 women. After matching participants by age in a 1:2 ratio, a total of 5210 postmenopausal women were included, with a median follow‐up of 15.53 years. Multivariable Cox proportional hazards models were employed to evaluate the associations between metabolic syndrome and incident cardiovascular disease, including cerebrovascular disease and myocardial infarction, while adjusting for confounding variables. Stratified and sensitivity analyses were conducted to validate the robustness of the findings. Results During follow‐up there were 398 incident CVD events (MetS−: 197; MetS+: 201). After full adjustment, MetS was associated with a two‐fold higher CVD risk (HR 2.01, 95% CI 1.64–2.46). Comparable associations were observed for the subtypes: cerebrovascular disease (HR, 1.83; 95% CI, 1.47–2.27) and myocardial infarction (HR, 3.28; 95% CI, 1.97–5.46). The association was strongest in women with early menopause (⟨45 years) (HR 3.86, 95% CI 1.29–11.53). Among MetS components, elevated fasting blood glucose appeared the largest contributor: excluding the glucose component reduced the overall MetS–CVD HR from 2.01 to 1.82 (95% CI 1.48–2.24). Results were robust in sensitivity analyses. Conclusions Postmenopausal women with metabolic syndrome have significantly higher risks of cardiovascular disease. In subgroup analyses, these findings were more pronounced among those with early menopause or elevated fasting blood glucose. In Conclusion, the findings underscore the importance of early detection of metabolic syndrome and targeted prevention strategies to reduce cardiovascular morbidity and mortality in this high risk population.