Exposure-weighted scoring for metabolic syndrome and the risk of myocardial infarction and stroke: a nationwide population-based study

Abstract

Background Metabolic syndrome (MetS) status changes over time, but few studies have investigated the relationship between the extent or duration of exposure to MetS and the risk of cardiovascular disease (CVD). We investigated the cumulative effects of MetS and its components on the risk of myocardial infarction (MI) and stroke. Methods From the Korean National Health Insurance database, 2,644,851 people who received annual health examinations from 2010 to 2013 were recruited. Exposure-weighted scores for MetS during this 4-year period were calculated in two ways: cumulative number of MetS diagnoses (MetS exposure score, range: 0–4) and the composite of its five components (MetS component exposure score, range: 0–20). The multivariable Cox proportional-hazards model was used to assess CVD risk according to the exposure-weighted scores for MetS. Results MetS was identified at least once in 37.6% and persistent MetS in 8.2% of subjects. During the follow-up (median, 4.4 years), 10,522 cases of MI (0.4%) and 10,524 cases of stoke (0.4%) occurred. The risk of MI and stroke increased gradually with increasing exposure scores of MetS and its components (each P for trend < 0.0001). The hazard ratio [(HR) (95% CI)] of MI and stroke were 5.27 (4.20–6.62) and 3.90 (3.09–4.93), respectively, in those with a score of 20 compared with those with a MetS component exposure score of 0. People fulfilling only two MetS components out of 20 already had 22% increased risk of MI, and those with three MetS components had 24% increased risk of stroke. These associations were consistent in the subgroup and sensitivity analyses. Conclusions A dose–response relationship between the cumulative exposure to metabolic disturbances and incident MI or stroke was evident. Even minimal exposure to MetS components was sufficient to increase the risk of CVD significantly, highlighting the importance of intensive risk management for the prevention of CVD.

Cumulative burden of metabolic syndrome and its components on the risk of atrial fibrillation: a nationwide population-based study

“…Meanwhile, elevated BP and low HDL-C levels have the most prominent increase in AF risk, which is consistent with prior research [ 11 , 27 ]. Impaired fasting glucose showed only a modest increase in AF development, consistent with a recent study evaluating the impact of ‘exposure’ to metabolic syndrome on the increased risk of MI and stroke, both sharing common predisposing factors with AF [ 21 ]. Although the exact underlying mechanisms explaining the differences in magnitudes of AF risk among metabolic components are not answered in the present study, we could hypothesize that elevated BP and adverse lipid profiles play more pivotal roles on substrate formation for AF development.…”

“…However, MetS status and its components are variable as they can change over time dynamically. A recent study demonstrated the association between the exposure duration or extent of metabolic disturbances and the increased risk of MI and stroke, which are AF-related complications [ 21 ]. Nonetheless, to what extent the time-burden of MetS affects the risk of AF itself has not been evaluated.…”

Using Latent Class Analysis to Identify Different Risk Patterns for Patients With Masked Hypertension

“…The results showed that more MACE occurred in Class 1; in particular, there were increased incidences of stroke and CHD. A large cohort study which recruited more than 2 million people found an obvious dose-response relationship between cumulative exposure to metabolic disorders and stroke, as people with three metabolic factors had a 24% increased risk of stroke ( 22 ). As for CHD, a Mendelian randomization study suggested that the loci associated with the direct action of HDL-C and triglycerides appeared to have location- and mechanism-specific causality on coronary artery disease ( 23 ).…”

Current Trends of Big Data Research Using the Korean National Health Information Database

“…The presence of dyslipidemia was defined as the presence of at least one claim per year under ICD-10 code E78 and at least one claim per year for the prescription of lipid-lowering agents or total cholesterol ≥240 mg/dL (Table 4) [14][15][16]. Lipid-lowering drugs include statins, ezetimibe, and fibrates.…”