Estimated vascular age using the Framingham model as a predictor of metabolic syndrome in a large cohort of Spanish workers.

BACKGROUND: Vascular age, estimated using the Framingham model, is an intuitive indicator of cardiovascular risk. Metabolic syndrome (MetS) includes several cardiometabolic abnormalities associated with increased morbidity and mortality. The relationship between vascular age and MetS has not been extensively assessed in large working populations. OBJECTIVE: To evaluate the predictive ability of vascular age for identifying MetS in a large cohort of Spanish workers. METHODS: We conducted a cross-sectional study among 336,450 employees aged 18-69 years who underwent standardized occupational health examinations from 2018 to 2022. Vascular age and avoidable lost life years (ALLY) were calculated using the Framingham equation. MetS was defined according to NCEP ATP III, IDF, and Joint Interim Statement (JIS) criteria. Associations were examined using logistic regression models adjusted for sociodemographic and lifestyle variables. Discriminatory performance was assessed through ROC curve analyses. RESULTS: MetS prevalence increased progressively across higher vascular age categories in both sexes. Vascular age demonstrated strong diagnostic performance, with areas under the curve>0.80 and reaching 0.86 in women according to NCEP ATP III and JIS definitions. Multivariable analyses confirmed independent associations between elevated vascular age and MetS. CONCLUSIONS: Vascular age is a strong and consistent predictor of MetS and represents a practical tool for early cardiometabolic risk detection in occupational settings. Its integration into workplace health surveillance may enhance the identification of high-risk workers and support targeted preventive strategies.