The new definition of metabolic syndrome including hyperuricemia improves its prognostic value: results from NHANES...

Metabolic syndrome (MetS) is a significant global health issue that is strongly associated with an increased risk of cardiovascular disease (CVD). While MetS was initially proposed to identify more high-risk individuals and facilitate early management, hyperuricemia has not yet been included in its definition, despite its strong association with MetS. This study aims to explore the prognostic value of incorporating hyperuricemia into the definition of MetS.

Data derived from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018 were analyzed. The old version of MetS (MetS_old) aligned with NCEP-ATP III criteria, whereas the new version of MetS (MetS_new) included hyperuricemia as a sixth criterion. Baseline characteristics were compared between participants with and without MetS, and outcomes were assessed by multivariate analyses.

Among the 36,363 participants analyzed, 12,594 (34.6%) and 14,137 (38.9%) met MetS_old and MetS_new criteriarespectively. Compared to MetS_old, MetS_new identified additional 1534(4.24%) participants at metabolic risk. Both MetS_old and MetS_new were significantly associated with long-term all-cause and CVD mortality (all P < 0.001). Furthermore, the additional participants identified by MetS_new exhibited a similar risk of all-cause and CVD mortality as those meeting MetS_old criteria. MetS_new demonstrated enhanced identification and reclassification abilities compared to MetS_old, as evidenced by improvement in C-index, NRI and IDI.

The inclusion of hyperuricemia in the MetS criteria could identify a larger proportion of individuals at metabolic risk, thereby facilitating early management to prevent long-term adverse events.