Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea.
Department of Internal Medicine Seoul National University College of Medicine Seoul Republic of Korea.
Department of Statistics and Actuarial Science Soongsil University Seoul Republic of Korea.
Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Chest & Heart Hospital Liverpool United Kingdom.
Department of Clinical Medicine Aalborg University Aalborg Denmark.
Abstract
Backgroud There is a paucity of information on whether changes in metabolic syndrome (MetS) status affect the risk of new-onset atrial fibrillation (AF). We aimed to evaluate whether changes in MetS status and components of MetS affect AF risk using data from a nationwide observational cohort. Methods and Results A total of 7 565 531 adults without prevalent AF (mean age, 47±14 years) who underwent 2 serial health examinations by the Korean National Health Insurance Cooperation were identified. The patients were categorized into 4 groups according to the change in MetS status in serial evaluations, as follows: patients with persistent MetS (n=1 388 850), healthy patients newly diagnosed with MetS in the second evaluation (n=608 158), patients with MetS who were healthy in the second evaluation (n=798 555), and persistently healthy individuals (n=4 769 968). During a mean 7.9-year follow-up, incident AF was diagnosed in 139 305 (1.8%) patients. After multivariable adjustment, the AF risk was higher by 31% in the patients with persistent MetS , 26% in the patients with MetS who were healthy in the second evaluation, and 16% in the healthy patients newly diagnosed with MetS in the second evaluation compared with the persistently healthy individuals. Regardless of the MetS component type, the AF risk correlated with changes in the number of components. The risk of AF was strongly correlated with MetS status changes in the young and middle-age groups (20-39 years and 40-64 years, respectively) than in the elderly group (≥65 years). Conclusions Dynamic changes in MetS status and persistent MetS were associated with an increased risk of AF in a large-scale Asian population.
Keywords
atrial fibrillationmetabolic syndromerisk factor
Figures
Figure 1 Study population stratified flow according to the change of metabolic syndrome status and those of metabolic components. Figure 2 The risk of atrial fibrillation (AF) according to the changes in metabolic syndrome (MetS) status. A, Proportion of each study group according to MetS status change. B, Risk of AF according to MetS status changes. HR indicates hazard ratio. *The definition of each divided group is as follows: HH, patients who were metabolically healthy at both examinations; HM, patients who were metabolically healthy at the first examination but were newly diagnosed with MetS at the second examination; MH, patients with MetS at the first examination but became metabolically healthy at the second examination; and MM, patients who met MetS criteria at both health examinations. †Multivariable models adjusted for age, sex, alcohol consumption, smoking status, physical activity, and body mass index.Figure 3 Study population distribution and the risk of atrial fibrillation (AF) according to changes in metabolic syndrome (MetS) components based on the number of components in the first health examination. A, Risk of AF according to changes in MetS components of patients who had 0 or 1 component in the first health examination. B, Risk of AF according to changes in MetS components of patients who had 2 components in the first health examination. C, Risk of AF according to changes in MetS components of patients who had 3 components in the first health examination. D, Risk of AF according to changes in MetS components of patients who had ≥4 components in the first health examination. Ref, reference; NC, no change in the number of MetS components; Inc, increase in the number of MetS components; and Dec, decrease in the number of MetS components. *Multivariable models adjusted for age, sex, alcohol consumption, smoking status, physical activity, and body mass index.Figure 4 Study population distribution and the risk of atrial fibrillation (AF) according to the changes in metabolic syndrome (MetS) components based on the number of components in the second health examination. A, Risk of AF according to changes in MetS components of patients who had 0 or 1 component in the second health examination. B, Risk of AF according to changes in MetS components of patients who had 2 components in the second health examination. C, Risk of AF according to changes in MetS components of patients who had 3 components in the second health examination D, Risk of AF according to changes in MetS components of patients who had ≥4 components in the second health examination. Ref, reference; NC, no change in the number of MetS components; Inc, increase in the number of MetS components; Dec, decrease in the number of MetS components. *Multivariable models adjusted for age, sex, alcohol consumption, smoking status, physical activity, and body mass index.Figure 5 The risk of atrial fibrillation (AF) according to the changes in metabolic syndrome (MetS) status by age groups. A, Risk of AF according to MetS status changes by age groups. B, Risk of AF according to waist circumference status changes by age groups. C, Risk of AF according to blood pressure (BP) status changes by age groups. D, Risk of AF according to fasting glucose status changes by age groups. E, Risk of AF according to triglyceride status changes by age groups. F, Risk of AF according to high‐density lipoprotein cholesterol (HDL‐C) status changes by age groups. †The definition of each divided group (HH, HM, MH, MM) same as Figure 2. ‡Subjects stratified into four groups according to the change of relevant component of metabolic syndrome as follows: UU, metabolically unhealthy of relevant component in both checkups; UH, metabolically unhealthy of relevant component in the first exam but changed to healthy in the second checkup; HU, metabolically healthy of relevant component in the first exam but changed to unhealthy in the second checkup; and HH, metabolically healthy of relevant component in both checkups. AF, atrial fibrillation; BP, blood pressure; HDL, high‐density lipoprotein cholesterol; MetS, metabolic syndrome; TG, triglyceride.
그림 출처: PubMed Central 공개 논문 (PMC8475027)
Conflict of interest statement
Eue‐Keun Choi received research grants from Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daiichi‐Sankyo, Samjinpharm, Sanofi‐Aventis, Seers Technology, Skylabs, and Yuhan. Gregory Y.H. Lip is a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi‐Sankyo and a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi‐Sankyo. No fees were personally received. The remaining authors have no disclosures to report.
그 밖의 정보
출판 형태
Journal Article, Observational Study, Research Support, Non-U.S. Gov't
저널
Journal of the American Heart Association · eISSN 2047-9980
