A 10-year study of patients with metabolic syndrome found that central obesity, elevated fasting blood glucose, and high blood pressure are the strongest predictors of coronary artery disease and associated mortality. The prospective cohort, presented at ESC 2025, followed 3,748 participants with metabolic syndrome from an initial group of 9,704 individuals. During the decade-long follow-up, 505 participants developed coronary artery disease, and 81 died from it.

Analysis revealed that individuals with three key components—high waist circumference, fasting blood glucose, and blood pressure—had more than double the risk of developing coronary artery disease. Adding lipid abnormalities such as triglycerides and low high-density lipoprotein only slightly changed the risk for disease development, but the presence of all metabolic syndrome components increased the risk of coronary artery disease-related death threefold.

The findings highlight the importance of targeting obesity, blood sugar, and blood pressure in preventive strategies, suggesting that early intervention on these factors could reduce the long-term burden of coronary artery disease in patients with metabolic syndrome.