Front Cardiovasc Med. 2023;10:1208979.

Impact of components of metabolic syndrome on the risk of adverse renal outcomes in patients with atrial fibrillation: a nationwide cohort study.

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제1저자 권순일, 이소령 · 교신저자 최의근

PMID 37915744 PMC10616466 DOI 10.3389/fcvm.2023.1208979 IF 3 순환기내과

소속 (6)

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 Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Chest & Heart Hospital, Liverpool, United Kingdom.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Abstract

BACKGROUND The renal effect of metabolic syndrome components is unclear in patients with atrial fibrillation. This study aimed to investigate the association between metabolic syndrome components and incident end-stage renal disease among patients with atrial fibrillation.

METHODS A total of 202,434 atrial fibrillation patients without prevalent end-stage renal disease were identified from the National Health Insurance Service database between 2009 and 2016. We defined the metabolic score range from 0 to 5 points such that a patient received every 1 point if the patient met each component listed in the diagnostic criteria of metabolic syndrome. The population was divided into 6 groups: MS₀-MS₅ for a metabolic score of 0-5, respectively. Multivariate Cox regression analysis was used to estimate the risks of end-stage renal disease.

RESULTS There were 12,747, 31,059, 40,361, 48,068, 46,630, and 23,569 patients for MS₀-MS₅, respectively. Compared with MS₀, MS₅ had a higher CHA₂DS₂-VASc score (3.8 vs. 1.0) (P < .001). During a median follow-up of 3.5 years, compared with MS₀, MS₁-MS₅ were associated with a gradually increasing incidence of end-stage renal disease, in relation to an increase in the metabolic score, (log-rank P < .001). After multivariate adjustment, a higher metabolic score was associated with a greater risk of incident end-stage renal disease: adjusted hazard ratio [95% confidence interval] = 1.60 [0.78-3.48], 2.08 [1.01-4.31], 2.94 [1.43-6.06], 3.71 [1.80-7.66], and 4.82 [2.29-10.15], for MS₁-MS₅, respectively.

CONCLUSIONS Metabolic syndrome components additively impacts the risk of incident end-stage renal disease among patients with atrial fibrillation.

Keywords

atrial fibrillationend-stage renal diseaseepidemiologymetabolic syndromerisk factor

Figures

**Figure 1** The flowchart of the study population. The study population was divided into 6 groups (MS0–MS5) according to each metabolic score (0–5). AF, atrial fibrillation; ESRD, end-stage renal disease; HDL-C, high-density lipoprotein cholesterol.

**Figure 2** The cumulative incidence of ESRD among AF patients according to the metabolic score. The crude incidence rates of ESRD increased significantly as metabolic score increased (P-for-trend <.001). AF, atrial fibrillation; ESRD, end-stage renal disease; MS, metabolic score.

**Figure 3** The risks of incident ESRD among AF patients across metabolic scores. There was a trend of increasing risks of incident ESRD for higher metabolic scores (P-for-trend <.001). AF, atrial fibrillation; CI, confidence interval; ESRD, end-stage renal disease; HR, hazard ratio; PY, person-year.

**Figure 4** Impact of metabolic components on the risks of incident ESRD; (A) systolic blood pressure; (B) fasting blood glucose; (C) waist circumference; (D) HDL-C; (E) triglyceride. CI, confidence interval; ESRD, end stage renal disease; HDL-C, high-density lipoprotein cholesterol; HR, adjusted hazard ratio; Ref, reference; SBP, systolic blood pressure.

그림 출처: PubMed Central 공개 논문 (PMC10616466)

Conflict of interest statement

SK, SRL, SWL, JHJ, KDH, HJA, SO: None to disclose. EKC: Research grants or speaking fees from Abbott, Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daewoong Pharmaceutical Co., Daiichi-Sankyo, DeepQure, Dreamtech Co., Ltd., Jeil Pharmaceutical Co. Ltd, Medtronic, Samjinpharm, Seers Technology, and Skylabs. GYHL: Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Anthos and Daiichi-Sankyo. No fees are received personally. GYHL is co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 899871.

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