The Impact of Metabolic Syndrome on the Incidence of Atrial Fibrillation: A Nationwide Longitudinal Cohort Study in South Korea
Abstract
:1. Introduction
2. Methods
2.1. Study Population
2.2. Definition of Metabolic Syndrome
2.3. Definition of Primary Outcome
2.4. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. Association between MetS Status and AF Risk
3.3. Impact of MetS Status and Components on the Risk of AF
4. Discussion
4.1. Comparison to Previous Studies
4.2. MetS and AF
4.3. Clinical Implications
4.4. Limitations
5. Conclusions
Author Contributions
Conflicts of Interest
References
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Variable | Normal N = 2,606,892 (33.3%) | Pre-MetS N = 3,972,572 (50.7%) | MetS N = 1,251,138 (15.9%) | p-Value |
---|---|---|---|---|
Age (years) at baseline | <0.001 | |||
30–39 | 796,857 (52.7) | 624,638 (41.3) | 91,002 (6.0) | |
40–49 | 769,361 (35.5) | 1,090,078 (50.4) | 304,487 (14.1) | |
50–59 | 705,192 (29.3) | 1,285,531 (53.4) | 418,382 (17.4) | |
60–69 | 335,482 (19.3) | 970,325 (55.7) | 437,267 (25.2) | |
Sex | <0.001 | |||
Male | 1,139,011 (25.6) | 2,415,161 (54.3) | 892,010 (20.1) | |
Female | 1,467,881 (43.4) | 1,557,411 (46.0) | 359,128 (10.6) | |
Smoking status | <0.001 | |||
Non-smoker | 1,727,253 (39.1) | 2,134,365 (48.3) | 553,548 (12.5) | |
Ex-smoker | 264,442 (24.7) | 581,953 (54.2) | 226,601 (21.1.) | |
Current smoker | 597,385 (26.0) | 1,233,704 (53.8) | 463,565 (20.2.) | |
Alcohol consumption | <0.001 | |||
No drink | 1,260,556 (36.0) | 1,745,471 (49.8) | 497,220 (14.2.) | |
2–3 per month | 1,080,613 (33.9) | 1,611,254 (50.5) | 497,186 (15.6.) | |
1–4 per week | 538,841 (34.1) | 795,190 (50.2) | 248,610 (15.7) | |
≥5 per week | 45,971 (18.7) | 135,990 (55.4) | 63,366 (25.8) | |
Exercise | ||||
No exercise | 1,216,659 (33.9) | 1,803,595 (50.2) | 569,220 (15.9) | |
1–4 per week | 538,841 (34.1) | 795,190 (50.2) | 248,610 (15.7) | |
≥5 per week | 828,890 (31.9) | 1,342,260 (51.7) | 423,684 (16.3) | |
Family history of HTN | <0.001 | |||
Yes | 231,065 (28.0) | 42,583 (51.5) | 169,292 (20.5) | |
No | 1,533,367 (34.1) | 2,271,217 (50.5) | 691,741 (15.4) | |
Family history of DM | <0.001 | |||
Yes | 206,381 (29.1) | 358,590 (50.5) | 144,595 (20.4) | |
No | 1,566,796 (33.8) | 2,353,078 (50.7) | 720,945 (15.5) | |
Family history of stroke | <0.001 | |||
Yes | 115,766 (27.4) | 224,443 (53.1) | 82,800 (19.6) | |
No | 1,656,733 (33.6) | 2,486,810 (50.5) | 792,319 (15.9) | |
Family history of coronary heart disease | <0.001 | |||
Yes | 80,356 (31.4) | 131,259 (51.3) | 44,348 (17.3) | |
No | 1,691,243 (33.2) | 2,577,805 (50.7) | 819,893 (16.1) |
Sex | MetS Status | Age Groups (Years) | |||
---|---|---|---|---|---|
30–39 | 40–49 | 50–59 | 60–69 | ||
Male | Normal | 5.03 | 12.32 | 34.40 | 85.99 |
Pre-MetS | 6.20 | 17.31 | 51.48 | 122.95 | |
MetS | 10.83 | 25.56 | 71.09 | 169.9 | |
p-value * | <0.001 | <0.001 | <0.001 | <0.001 | |
Female | No MetS | 1.21 | 4.04 | 11.65 | 34.07 |
Pre-MetS | 2.18 | 7.19 | 18.24 | 54.22 | |
MetS | 3.25 | 8.69 | 32.05 | 84.08 | |
p-value * | >0.05 | <0.01 | <0.001 | <0.001 |
Non-Adjusted HR (95% CI) | Multivariable HR * (95% CI) | |||
---|---|---|---|---|
Model 1 | Model 2 | Model 3 | ||
MetS status | ||||
Normal | 1 | 1 | 1 | 1 |
Pre-MetS | 2.43 (2.313–2.554) | 1.538 (1.463–1.617) | 1.532 (1.457–1.611) | 1.391 (1.322–1.464) |
MetS | 4.616 (4.379–4.866) | 2.219 (2.103–2.343) | 2.205 (2.089–2.328) | 1.722 (1.621–1.829) |
Sex | ||||
Female | 1 | 1 | 1 | |
Male | 2.332 (2.222–2.446) | 2.358 (2.247–2.475) | 1.969 (1.86–2.085) | |
Age group | ||||
30–39 | 1 | 1 | 1 | |
40–49 | 2.62 (2.327–2.95) | 2.596 (2.305–2.923) | 2.613 (2.319–2.944) | |
50–59 | 7.36 (6.58–8.233) | 7.227 (6.461–8.085) | 7.553 (6.748–8.455) | |
60–69 | 18.571 (16.622–20.747) | 18.258 (16.341–20.4) | 19.523 (17.46–21.83) | |
Smoking status | ||||
Non-smoker | 1 | 1 | 1 | |
Ex-smoker | 1.051 (1.0–1.105) | 1.04 (0.99–1.094) | 1.047 (0.996–1.101) | |
Current smoker | 1.017 (0.971–1.065) | 1.014 (0.969–1.062) | 1.034 (0.987–1.083) | |
Exercise | ||||
No exercise | 1 | 1 | 1 | |
1–4 per week | 0.949 (0.906–0.994) | 0.945 (0.902–0.99) | 0.943 (0.9–0.987) | |
≥5 per week | 1.009 (0.972–1.047) | 1.003 (0.996–1.041) | 0.99 (0.954–1.028) | |
Family history of HTN | ||||
No | 1 | 1 | ||
Yes | 1.14 (1.09–1.193) | 1.129 (1.079–1.181) | ||
Family history of stroke | ||||
No | 1 | 1 | ||
Yes | 1.139 (1.081–1.201) | 1.145 (1.086–1.208) | ||
Family history of coronary heart disease | ||||
No | 1 | 1 | ||
Yes | 1.259 (1.173–1.352) | 1.262 (1.175–1.356) | ||
Family history of DM | ||||
No | 1 | 1 | ||
Yes | 0.889 (0.844–0.937) | 0.887 (0.841–0.935) | ||
Body mass index (kg/m2) | 1.069 (1.062–1.075) | |||
Hemoglobin (g/dL) | 1.082 (1.066–1.099) | |||
Creatinine (mg/dL) | 1.002 (0.992–1.012) | |||
Total cholesterol (mg/dL) | 0.997 (0.997–0.998) | |||
LDL cholesterol (mg/dL) | 1.0 (0.999–1.001) | |||
ALT (IU/L) | 0.999 (0.998–1.0) |
Multivariable HR * (95% CI) | p-Value | |
---|---|---|
Abdominal obesity | 1.316 (1.256–1.379) | <0.0001 |
Elevated blood pressure | 1.451 (1.4–1.505) | <0.0001 |
Elevated fasting glucose | 1.163 (1.123–1.205) | <0.0001 |
High triglyceride | 0.944 (0.907–0.984) | 0.006 |
Low HDL cholesterol | 1.048 (1.003–1.096) | 0.038 |
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Kwon, C.H.; Kim, H.; Kim, S.H.; Kim, B.S.; Kim, H.-J.; Sung, J.D.; Kim, D.-K.; Han, S.W.; Ryu, K.-H. The Impact of Metabolic Syndrome on the Incidence of Atrial Fibrillation: A Nationwide Longitudinal Cohort Study in South Korea. J. Clin. Med. 2019, 8, 1095. https://doi.org/10.3390/jcm8081095
Kwon CH, Kim H, Kim SH, Kim BS, Kim H-J, Sung JD, Kim D-K, Han SW, Ryu K-H. The Impact of Metabolic Syndrome on the Incidence of Atrial Fibrillation: A Nationwide Longitudinal Cohort Study in South Korea. Journal of Clinical Medicine. 2019; 8(8):1095. https://doi.org/10.3390/jcm8081095
Chicago/Turabian StyleKwon, Chang Hee, Hyeongsu Kim, Sung Hea Kim, Bum Sung Kim, Hyun-Joong Kim, Ji Dong Sung, Duk-Kyung Kim, Seong Woo Han, and Kyu-Hyung Ryu. 2019. "The Impact of Metabolic Syndrome on the Incidence of Atrial Fibrillation: A Nationwide Longitudinal Cohort Study in South Korea" Journal of Clinical Medicine 8, no. 8: 1095. https://doi.org/10.3390/jcm8081095