To examine the metabolic syndrome (MetS) and its components as risk factors for a cardiovascular (CV) event, in individuals without diabetes and/or hypertension, and to explore which of the risk factors are the most predictive for cardiovascular disease (CVD) and whether the assessment of risk could be simplified.

A longitudinal, cross-sectional study.

A randomly selected population.

In 2002–2005, 2816 randomly selected residents of Skaraborg, Sweden, underwent physical examinations and blood tests as part of the Skaraborg Project. Exclusion of individuals with diabetes mellitus and/or hypertension at baseline left 2328 persons for analyses.

CV events were assessed in 2011 using national Swedish registers.

A total of 293 (13%) were defined as having the MetS according to the National Cholesterol Education Programme (NCEP) and 292 according to the International Diabetes Federation (IDF) definition, whereof 27 had a CV event after a mean follow-up time of 9.7 years. The MetS according to NCEP was significantly predictive of a CVD with an HR 2.4 (95% CI 1.4 to 3.9) but not according to the IDF definition. Blood pressure was significantly predictive according to both definitions (HR 1.77, 95% CI 1.06 to 2.97). Also, triglycerides (Tg) were significantly predictive for a CV event (HR 2.05, 95% CI 1.17 to 3.59). Neither waist circumference, high-density lipoprotein nor fasting plasma glucose was predictive for a CV event. Combining a blood pressure ≥125/≥80 mm Hg with Tg ≥1.5 mmol/L was predictive for CVD (HR 2.1, 95% CI 1.3 to 3.6) with a sensitivity of 32.5% and numbers needed to examine (NNE) 7.1. Lowering the cut-off for Tg to ≥1.2 mmol/L (HR 2.1, 95% CI 1.3 to 3.4) increased sensitivity to 44.9% and NNE became 8.

Using blood pressure combined with Tg was shown to be an equally good predictor for CVD as the complete MetS in individuals without diagnosed diabetes or hypertension. Therefore, healthcare personnel should pay attention to individuals with a borderline blood pressure, and if equivalent to or equal to 125/85, continue with measuring Tg for a discussion concerning lifestyle.

To assess the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with coexisting ischaemic heart disease (IHD) and type 2 diabetes (T2D) in primary care, in relation to European guidelines.

Cross-sectional observational study.

209 primary healthcare centres in Region Västra Götaland, Sweden (population 1.8 million in 2023).

14 414 patients with registered prevalent diagnoses of coexisting IHD and T2D, September 2023, in QregPV, the regional primary care quality of care register in Region Västra Götaland. Data on dispensed drugs were retrieved from the regional prescribed drug register, Digitalis.

The primary outcome was the proportion of patients with dispensed SGLT2i or GLP-1 RA in relation to sex, age and primary healthcare centres (including private vs public ownership). The secondary outcome was estimated additional prescription costs.

SGLT2i was dispensed to 37.2%, less often to women (adjusted OR (aOR) 0.64 (95% CI 0.59 to 0.70)). GLP-1 RA was dispensed to 10.0%, with no sex difference (aOR 1.04 (95% CI 0.92 to 1.18)). Use of SGLT2i and GLP-1 RA declined with age (p

SGLT2i and GLP-1 RA were underutilised in patients with coexisting IHD and T2D. The sex disparity in SGLT2i use warrants attention, as does the substantial variation between primary healthcare centres and the challenges of implementing costly cardioprotective therapies.