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OBJECTIVES: Although an association is known to exist between metabolic syndrome (MetS) and heart failure (HF) risk, large longitudinal studies are limited. We investigated metabolic status as a risk factor for HF in middle-aged men and women and considered sex differences in various risk factors for HF using nationwide real-world data. METHODS: Data obtained from the Korean National Health Insurance Service from 2009 to 2016 were analyzed. A total of 2,151,597 middle-aged subjects (between 50 and 59 years old) were enrolled. Subjects were divided into 3 groups (normal, pre‐ MetS, and MetS). Cox proportional hazard models were used to estimate the association between MetS and incident HF after adjusting for clinical risk factors. RESULTS: At baseline, MetS existed in 23.77% of men and 10.58% of women. Pre-MetS and MetS increased the risk of HF: the hazard ratios of pre-MetS for incident HF were 1.508 (95% confidence interval [CI], 1.287 to 1.767) in men and 1.395 (95% CI, 1.158 to 1.681) in women, and those of MetS were 1.711 (95% CI, 1.433 to 2.044) in men and 2.144 (95% CI, 1.674 to 2.747) in women. Current smoking, a low hemoglobin level, underweight (body mass index < 18.5 kg/m2 ), a high creatinine level, and acute myocardial infarction were also predictors of HF in both sexes. CONCLUSIONS: Pre-MetS and MetS were identified as risk factors for HF in middle-aged men and women. The effect of MetS on the occurrence of HF was stronger in women than in men. Pre-MetS was also a predictor of HF, but was associated with a lower risk than MetS.
