Factors associated with coronary artery disease in adults with metabolic syndrome: an analysis of data from the Korea National Health and Nutrition Examination Survey

Purpose: This study examined factors associated with coronary artery disease (CAD) among adults with metabolic syndrome using nationally representative survey data.Methods: A secondary analysis was conducted using data from the seventh (2016-2018) and eighth (2019-2021) Korea National Health and Nutrition Examination Surveys. Participants included 9,877 adults aged ≥ 19 years who met the National Cholesterol Education Program Adult Treatment Panel III criteria for metabolic syndrome. Complex sample analysis was applied, accounting for stratification, clustering, and weighting. Variables included sociodemographic, clinical, mental health, health behavior, and nutritional factors.Results: The prevalence of CAD among adults with metabolic syndrome was 5.6%. Older age, elevated systolic blood pressure, and higher total cholesterol were independently associated with CAD. Compared with adults aged 19-49 years, the adjusted odds ratios were 5.02 (95% confidence interval [CI] = 1.12-22.46) for those aged 50-59 years, 6.48 (95% CI = 1.16-36.04) for 60-69 years, and 7.77 (95% CI = 1.40-43.13) for ≥ 70 years. Participants with systolic blood pressure of 120-139 mmHg and ≥140 mmHg had 2.56 (95% CI = 1.10-5.95) and 3.69 (95% CI = 1.16-11.78) times higher odds, respectively. Total cholesterol levels of 200-239 mg/dL were associated with 3.65 times higher odds (95% CI = 1.13-11.78).Conclusion: Advanced age, elevated blood pressure, and borderline-to-high cholesterol were significantly associated with increased likelihood of CAD in adults with metabolic syndrome. These findings underscore the importance of early risk assessment and targeted preventive interventions for this high-risk population.