20-29 30-39 40-49 50-59 60-69 70-79 Total ≥1 ≥2 ≥3 ≥4 5 3 (60.0%) 7 (41.2%) 15 (31.3%) 19 (45.2%) 14 (35.9%) 5 (29.4%) 63 /168 (37.5/43.6%)* 94.0% 72.0% 37.5% 10.1% 0.6% *Crude/Age-adjusted prevalence. Table 6. Simultaneous fulfillment of metabolic criteria for patients with gout No. of criteria Percentage (ATP III) Modified ATP III Table 7. Multivariate analysis of the metabolic factors for patients with gout Gout and the Metabolic Syndrome Table 3. The prevalence of metabolic syndrome Criteria ATP III Modified ATP III Gout patients Control group 63 (37.5/43.6%) 98 (58.3/57.2%) 5.2% 22.1% p* <0.001 <0.001 *Chi-square test of homogeneity, crude/age-adjusted prevalence, From reference 10, study population 40,698, From reference 11, study popula- tion 6,147. Table 5. Fulfillment of the individual criteria for patients with gout Criteria Waist (ATP III) Waist (Modified ATP III) Triglyceride HDL Blood pressure Glucose Percentage 11.9% 66.1% 66.7% 35.1% 72.0% 28.6% than that of the control population (11). According to these results, gout is strongly associated with the metabolic syn- drome. The prevalence of metabolic syndrome according to the age groups is shown in Table 4. The prevalence is nearly uniform (50-60%) across the age groups when using the modi- fied ATP III criteria. The percentage of patients who fulfilled the individual components of the ATP III or modified ATP III criteria is shown in Table 5. Among the components, hyper- tension and hypertriglyceridemia were the most common components, and this is similar to both the control popula- tions. Table 6 shows the percentage of patients who simulta- neously fulfilled several components of each set of criteria in an incremental order. Seventy-two percent of the patients with gout had at least 2 components of metabolic syndrome (85.7% with the modified ATP III criteria), which is much higher than the values of 23.2% (ATP III) (10) or 46.4% (modified ATP III) (11) from the control populations. Factors associated with the metabolic syndrome in patients with gout The multivariate analysis displayed on Table 7 shows the independent variables associated with the occurrence of meta- bolic syndrome (ATP III criteria) with gout. The patients with higher body mass index (BMI) levels were at the great- est risk of having metabolic syndrome (OR 1.357, 95%CI 1.111-1.657, p= 0.003), while the patients with higher high density lipoprotein (HDL) levels were at the lowest risk (OR 0.774, 95% CI 0.705-0.850, p<0.001). When considering the difference in the weights of the units among the variables, (i.e., increasing BMI by 1 is far more difficult than increas- ing blood pressure or glucose by 1), systolic blood pressure (SBP) could be the strongest variable with an OR of 2.203 (increments in 10 mmHg). However, neither the urate levels nor the alcohol consumption levels were significantly asso- ciated with metabolic syndrome. Table 4. Prevalence of metabolic syndrome according to age groups Age (yr) Prevalence (ATP III) Factor Age (yr) BMI Systolic BP Diastolic BP FBS Triglycerides HDL LDL Urate Alcohol (Non) ≤30 g/day >30 g/day OR (95% CI) 1.002 (0.947-1.061) 1.357 (1.111-1.657) 1.082 (1.029-1.139) 1.019 (0.943-1.100) 1.070 (1.037-1.105) 1.005 (1.002-1.009) 0.774 (0.705-0.850) 1.014 (0.997-1.032) 0.869 (0.682-1.107) 1.000 0.806 (0.199-3.269) 1.589 (0.355-7.106) OR, Odds ratio; CI, Confidence interval; BMI, Body mass index; BP, Blood pressure; FBS, Fasting blood glucose. ATP III Criteria were used. DISCUSSION The concept of metabolic syndrome was first suggested by Reaven in 1988 (14), and it is now an acknowledged major risk factor for cardiovascular diseases in the ATP III guide- lines. Its components can be divided into hypertension, obe- sity, hyperglycemia and dyslipidemia. As gout is also gener- ally known to be associated with such metabolic abnormali- ties, it seems somewhat unusual that there have not been few, if not any, epidemiologic studies concerning the prevalence of metabolic syndrome in patients with gout up to this time. This study is the first in Korea to determine the association of metabolic syndrome with gout by performing a prevalence comparison with using the ATP III classification criteria. There 1031 Modified ATP III 3 (60.0%) 9 (52.9%) 25 (52.1%) 29 (69.0%) 22 (56.4%) 10 (58.8%) 98 /168 (58.3/57.2%)* 95.8% 85.7% 58.3% 24.4% 4.2% p 0.932 0.003 0.002 0.641 <0.001 0.002 <0.001 0.110 0.256 0.607 0.763 0.545