Association of Cigarette Smoking and Metabolic Syndrome in a Puerto Rican Adult Population

Metabolic syndrome (MetSyn) is related to an increased risk for type 2 diabetes and cardiovascular disease. Smokers are at
greater risk than nonsmokers of becoming insulin resistant and to develop cardiovascular disease. This study aimed to explore
the association between cigarette smoking, MetSyn and its components among Puerto Rican adults. A representative sample of
856 persons aged 21–79 years from the San Juan Metropolitan area participated in this study. Demographic and lifestyle characteristics,
including smoking habits, were gathered from a self-reported questionnaire. MetSyn was defined according to the revised NCEP-ATP
III criteria and measured using biochemical measurements and anthropometric indices. Logistic regression models were used
to estimate prevalence odds ratios (POR) and its 95 % confidence intervals (CI). MetSyn was significantly (P < 0.001) more prevalent in former smokers (48.4 %) as compared to current (42.7 %) and never smokers (40.0 %). However, after
adjusting for possible confounders, current smokers who used more than 20 cigarettes per day were 2.24 (95 % CI = 1.00–4.99)
times more likely to have MetSyn as compared to never smokers. Heavy smokers were also more likely to have high triglyceride
levels (POR = 2.22, 95 % CI = 1.12–4.38) and low HDL-cholesterol levels (POR = 2.49, 95 % CI = 1.28–4.86) as compared to never
smokers. This study supports previous reports of an increased risk of MetSyn among current smokers, particularly those with
a heavier consumption. Tobacco control strategies, such as preventing smoking initiation and disseminating evidence-based
cessation programs, are necessary to reduce the burden of MetSyn in Puerto Rico.