Metabolic syndrome and venous thromboembolism: the role of abdominal obesity and sex differences.

Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors, including abdominal obesity, insulin resistance, dyslipidemia, and hypertension. Its association with venous thromboembolism (VTE) has been inconsistently reported. We investigated the association between MetS and VTE, and the influence of sex and abdominal obesity. We included 12,788 middle-aged and older adults from the re-examination phase of the Swedish prospective cohort Malmö Preventive Project (2002-2006). VTE events were collected using national registers until 31 December 2018. MetS was defined as the presence of three or more of the following factors: abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, hypertension, and impaired fasting glucose. During a mean follow-up of 11 years, 730 first VTE events occurred. The prevalence of MetS was higher in men than in women (p < 0.001). In analyses adjusted for age, height, and smoking, MetS was not associated with increased risk of VTE in men (HR 1.10; 95% CI 0.90-1.34) or women (HR 1.15; 95% CI 0.91-1.45). In women, higher VTE risk was found in those with multiple MetS factors compared to zero. Abdominal obesity was associated with VTE risk in women only (HR 1.80; 95% CI 1.43-2.27). MetS was not associated with VTE risk in men or women. The higher VTE risk observed with multiple MetS components in women appeared largely attributable to abdominal obesity, with little contribution from other components. Risk factors for VTE may differ by sex, with abdominal obesity appearing particularly relevant for women.