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A number of factors used to define the metabolic syndrome (MS) differ between African-American and European-American patients, which raises the question whether the individual constellation of MS components would impact cardiovascular risk. Our objectives were to assess the association between the MS and coronary artery disease (CAD) across ethnicities and to explore whether the constellation used to define the syndrome would impact any such association. We studied the distribution of the MS and its relation to CAD in 304 European-American subjects and 224 African-American subjects undergoing diagnostic coronary angiography. The overall prevalence of the MS in European-American and African-American subjects were 65.5% and 49.1%, respectively. Compared with European-American subjects, the lipid components of the syndrome were less frequent among African-American subjects (44% vs 64% [p <0.001] for high-density lipoprotein [HDL] cholesterol and 21% vs 51% [p <0.001] for triglyceride, respectively). The prevalence of CAD was significantly higher in subjects with MS across ethnicity (71.1% of European-American subjects and 56.6% of African-American subjects, p = 0.017 and p = 0.046, respectively). Multiple regression analyses demonstrated an association of blood pressure and HDL cholesterol with CAD among European-American subjects, which remained significant taking other risk factors into account (r(2) = 0.542, p <0.001). In conclusion, presence of CAD was more common among subjects with MS independently of ethnicity. Of the MS components, blood pressure was associated with CAD among European-American subjects. Although our findings may not be directly extrapolated to the population at large, they illustrate the importance of a high-risk metabolic environment as a cardiovascular risk factor.

The hypothesis was tested that plasma levels of adiponectin would be associated with coronary artery disease (CAD) across African-American and Caucasian ethnicity and gender. Adiponectin levels, cardiovascular risk factors, and extent of CAD were measured in 453 subjects (173 African-American and 280 Caucasian men and women). The distribution of adiponectin levels differed significantly between African-Americans and Caucasians (P<0.0001). Among African-Americans, the adiponectin distribution was skewed toward lower levels. For women, adiponectin levels were higher among Caucasians compared with African-Americans (P<0.001), whereas no interethnic difference was observed for men. Irrespective of ethnic group, subjects with CAD had lower levels of adiponectin than did subjects without CAD. Adiponectin was negatively and significantly associated with waist-hip ratio, body mass index, diastolic blood pressure, insulin level, and homeostasis model assessment-insulin resistance in both ethnic groups. Among lipid parameters, total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels were negatively correlated with adiponectin, whereas the high-density lipoprotein cholesterol level correlated positively for both African-Americans and Caucasians. In a multiple regression model, controlling for gender, ethnicity, and other CAD risk factors, adiponectin levels were negatively associated with CAD (P<0.05). The results indicate that, across gender and ethnicity, low adiponectin levels may be an independent risk factor for CAD.