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Association between diabetes, metabolic syndrome and heart attack in US adults: a cross-sectional analysis using the Behavioral Risk Factor Surveillance System 2015
  1. Guang-Ran Yang1,2,
  2. Timothy D Dye2,
  3. Dongmei Li2
  1. 1 Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
  2. 2 Clinical and Translational Science Institute, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
  1. Correspondence to Dr Guang-Ran Yang; gr.yang{at}; Professor Dongmei Li; Dongmei_li{at}


Objectives Diabetes mellitus (DM) and metabolic syndrome (MS) are both associated with heart attack. Evidence regarding which condition—MS or DM—is better associated with heart attack, however, is limited. The purpose of this study is to examine DM and MS, and their comparative associations with heart attack, using the 2015 Behavioral Risk Factor Surveillance System (BRFSS).

Design Cross-sectional study.

Methods A total of 332 008 subjects aged over 18 years were included in the analysis. All subjects were classified into four groups based on their DM and MS status: neither DM nor MS, DM without MS, MS without DM, and both DM and MS. A weighted hierarchical logistic regression was used to examine the difference between the four groups in their association with the risk of a heart attack.

Results Differences in weighted frequency distributions of gender, age category (over 45 years or not), smoking status, education, race, physical activity and daily vegetable and fruit consumption were significantly different across the four groups (p<0.05). The weighted prevalence of heart attack was 5.2% for neither DM nor MS group, 8.5% for DM without MS group, 11.0% for MS without DM group and 16.1% for both DM and MS group. The weighted prevalence of heart attack in MS without DM group was significantly higher than that in the DM without MS group (p<0.01). After adjusting for confounding variables, DM without MS and MS without DM were both found to be independently associated with heart attack compared with those without DM nor MS (DM without MS, OR=2.09; MS without DM, OR=2.58, all p<0.01).

Conclusion The BRFSS 2015 data indicated that MS without DM and DM without MS had comparable effects on heart attack, and the odds of risk are doubled than US adults with neither DM nor MS.

  • metabolic syndrome
  • diabetes
  • heart attack

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  • Contributors GRY and DL designed the study and analysed the data. GRY drafted the manuscript. DL and TDD revised the manuscript. All authors read and approved the final manuscript.

  • Funding This work was supported by Beijing Municipal Training Foundation for Highly Qualified and Technological Talents of Health System (2014-3-013) and Capital's Funds for Health Improvement and Research (2016-2-2054). DL and TDD’s time is partly supported by the University of Rochester’s Clinical and Translational Science Award (CTSA) (numbers UL1 TR000042 and UL1 TR002001) from the National Center for Advancing Translational Sciences of the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The 2015 BRFSS annual survey data do not include any identifiable information and are publicly available from the Centers for Disease Control and Prevention website (

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All the data are publicly available from the Centers for Disease Control and Prevention website (

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