Plasminogen Activator Inhibitor‐1 and Diagnosis of the Metabolic Syndrome in a West African Population

Background Metabolic syndrome (MetS) is diagnosed by the presence of at least 3 of the following: obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low high‐density lipoprotein. Individuals with MetS also typically have elevated plasma levels of the antifibrinolytic factor, plasminogen activator inhibitor‐1 (PAI‐1), but the relationships between PAI‐1 and MetS diagnostic criteria are not clear. Understanding these relationships can elucidate the relevance of MetS to cardiovascular disease risk, because PAI‐1 is associated with ischemic events and directly involved in thrombosis. Methods and Results In a cross‐sectional analysis of 2220 Ghanaian men and women from urban and rural locales, we found the age‐standardized prevalence of MetS to be as high as 21.4% (urban women). PAI‐1 level increased exponentially as the number of diagnostic criteria increased linearly ( P <10−13), supporting the conclusion that MetS components have a joint effect that is stronger than their additive contributions. Body mass index, triglycerides, and fasting glucose were more strongly correlated with PAI‐1 than with canonical MetS criteria, and this pattern did not change when pair‐wise correlations were conditioned on all other risk factors, supporting an independent role for PAI‐1 in MetS. Finally, whereas the correlations between conventional risk factors did not vary significantly by sex or across urban and rural environments, correlations with PAI‐1 were generally stronger among urban participants. Conclusions MetS prevalence in the West African population we studied was comparable to that of the industrialized West. PAI‐1 may serve as a key link between MetS, as currently defined, and the endpoints with which it is associated. Whether this association is generalizable will require follow‐up.