Association of Metabolic Syndrome with Ischemic Changes in Electrocardiogram: Result from a Population-Based Study in the North-East of Iran

<b><i>Background:</i></b> Ischemic changes in the electrocardiogram (ECG), along with metabolic syndrome (MetS) and its components, can be utilized to predict cardiovascular diseases (CVDs). However, the exact association between MetS components and ECG abnormalities is not well established. This study was designed to verify this association. <b><i>Methods:</i></b> This cross-sectional study was conducted on individuals aged 35-65 years as part of the population-based Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study. Participants were allocated into two groups based on the presence of MetS. ECGs were coded using the Minnesota coding system. The association between each MetS component and every ischemic ECG presentation was analyzed separately. <b><i>Results:</i></b> Among the 9,035 available ECG data, the overall prevalence of ischemic ECG presentations was significantly higher in those with MetS than in those without (<i>P</i> < 0.05), except for minor ischemia (<i>P</i> = 0.787). Multiple logistic regression analysis showed that MetS was independently associated with major ischemia presentation in ECG (OR = 1.254, 95% CI 1.103-1.425, <i>P</i> < 0.001), but no association was found with minor ischemia after adjustment for age, sex, smoking, CVD family history, and physical activity level. Among MetS components, triglycerides, fasting blood glucose, waist circumference, and systolic and diastolic blood pressures were significantly associated with ischemic ECG presentations. Elevated high-density lipoprotein cholesterol level had a negative association with ischemic ECG presentations, while it had a significant positive association only with ST-segment elevation (OR = 1.021, 95% CI 1.011-1.031, <i>P</i> < 0.001). <b><i>Conclusions:</i></b> MetS and its components showed an association with ischemic ECG presentations, but these associations varied based on each MetS component and ischemic ECG abnormality.