1Yonsei University Wonju College of Medicine, Wonju, Korea
2Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
3Department of Precision Medicine & Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
4Big Data Streering Department, National Health Insurance Service, Wonju, Korea
5Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
6Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
Copyright © 2021 Korean Diabetes Association
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Characteristic | Total | MS score 1st quartile | MS score 2nd quartile | MS score 3rd quartile | MS score 4th quartile | P value |
---|---|---|---|---|---|---|
Number | 2,541,364 | 635,341 | 635,341 | 635,341 | 635,341 | |
MS score (standard error) | –0.12 (0.28) | –1.04 (0.32) | –0.38 (0.14) | 0.10 (0.14) | 0.84 (0.41) | <0.001 |
Age, yr | 47.52±5.35 | 46.72±5.23 | 47.35±5.30 | 47.87±5.39 | 48.14±5.49 | <0.001 |
BMI, kg/m2 | 23.52±2.33 | 21.57±2.09 | 22.94±2.19 | 24.05±2.32 | 25.54±2.68 | <0.001 |
Waist circumference, cm | 79.32±6.52 | 73.69±6.08 | 77.56±6.37 | 80.91±6.51 | 85.14±7.09 | <0.001 |
Male sex | 1,340,573 (52.75) | 325,324 (51.20) | 311,191 (48.98) | 340,135 (53.54) | 363,923 (57.28) | <0.001 |
Systolic BP, mm Hg | 119.60±10.68 | 115.10±10.55 | 118.08±10.58 | 120.75±10.59 | 124.45±10.97 | <0.001 |
Diastolic BP, mm Hg | 75.25±7.57 | 72.38±7.50 | 74.26±7.53 | 75.99±7.53 | 78.37±7.72 | <0.001 |
Fasting glucose, mg/dL | 94.43±11.95 | 89.61±8.30 | 92.20±8.85 | 94.68±9.88 | 101.25±18.07 | <0.001 |
Total cholesterol, mg/dL | 199.44±30.81 | 190.14±28.70 | 195.59±30.05 | 201.98±31.11 | 210.05±33.20 | <0.001 |
Triglyceride, mg/dL | 131.01±58.67 | 72.58±22.91 | 99.61±30.80 | 133.41±43.69 | 218.43±101.91 | <0.001 |
HDL-C, mg/dL | 55.50±9.80 | 65.56±11.74 | 57.34±9.66 | 52.36±8.99 | 46.75±8.49 | <0.001 |
LDL-C, mg/dL | 117.88±28.36 | 109.71±25.42 | 118.09±26.98 | 122.88±28.43 | 120.84±32.16 | <0.001 |
Family income quartiles | <0.001 | |||||
Q1 | 542,415 (21.34) | 135,128 (21.27) | 139,475 (21.95) | 134,460 (21.16) | 133,352 (20.99) | |
Q2 | 489,681 (19.27) | 128,167 (20.17) | 124,446 (19.59) | 119,611 (18.83) | 117,457 (18.49) | |
Q3 | 601,366 (23.66) | 149,225 (23.49) | 146,502 (23.06) | 149,913 (23.60) | 155,726 (24.51) | |
Q4 | 907,902 (35.72) | 222,821 (35.07) | 224,918 (35.40) | 231,357 (36.41) | 228,806 (36.01) | |
Heavy drinker | 514,038 (20.23) | 112,658 (17.73) | 115,194 (18.13) | 129,835 (20.44) | 156,351 (24.61) | <0.001 |
Current smoker | 612,115 (24.25) | 134,517 (21.32) | 135,546 (21.48) | 155,636 (24.66) | 186,416 (29.54) | <0.001 |
Regular exercise | 844,681 (33.24) | 221,366 (34.84) | 212,598 (33.46) | 209,223 (32.93) | 201,494 (31.71) | <0.001 |
MS present (ATP-III) | 251,317 (9.89) | 201 (0.03) | 2,544 (0.40) | 22,569 (3.55) | 226,003 (35.57) | <0.001 |
MS component number | <0.001 | |||||
0 | 1,045,421 (41.14) | 501,767 (78.98) | 369,595 (58.17) | 162,442 (25.57) | 11,617 (1.83) | |
1 | 790,055 (31.09) | 119,341 (18.78) | 220,781 (34.75) | 310,096 (48.81) | 139,837 (22.01) | |
2 | 454,571 (17.89) | 14,032 (2.21) | 42,421 (6.68) | 140,234 (22.07) | 257,884 (40.59) | |
3 | 193,171 (7.60) | 201 (0.03) | 2,539 (0.40) | 22,039 (3.47) | 168,392 (26.50) | |
4 | 51,930 (2.04) | 0 | 5 (0.00) | 530 (0.08) | 51,395 (8.09) | |
5 | 6,216 (0.24) | 0 | 0 | 0 | 6,216 (0.98) | |
Hypertension | 140,282 (5.52) | 13,960 (2.20) | 22,974 (3.62) | 35,757 (5.63) | 67,591 (10.64) | <0.001 |
Diabetes | 45,930 (1.81) | 1,037 (0.16) | 2,426 (0.38) | 5,946 (0.94) | 36,521 (5.75) | <0.001 |
Medication for dyslipidemia | 223,301 (8.79) | 26,472 (4.17) | 41,094 (6.47) | 60,206 (9.48) | 95,529 (15.04) | <0.001 |
Variable | Person-year | No. of events | Incidence rate (10,000 person-year) | HR (95% CI) | Multivariate HR (95% CI) |
||
---|---|---|---|---|---|---|---|
Model 1 | Model 2 | ||||||
Risk of ischemic stroke or myocardial infarction according to MS score quartiles | |||||||
Total no. | 15,219,169.53 | 15,762 | 10.36 | 2,541,364 | 2,524,015 | 2,524,015 | |
MS score 1st quartile | 3,808,590.65 | 2,197 | 5.77 | 1 | 1 | 1 | |
MS score 2nd quartile | 3,806,562.79 | 3,148 | 8.27 | 1.43 (1.36–1.51) | 1.31 (1.24–1.38) | 1.26 (1.19–1.33) | |
MS score 3rd quartile | 3,804,195.27 | 4,201 | 11.04 | 1.92 (1.82–2.02) | 1.56 (1.48–1.65) | 1.43 (1.35–1.51) | |
MS score 4th quartile | 3,799,820.82 | 6,216 | 16.36 | 2.84 (2.70–2.98) | 2.05 (1.94–2.17) | 1.67 (1.58–1.77) | |
P for trend | <0.001 | <0.001 | <0.001 | ||||
Risk of ischemic stroke according to MS score quartiles | |||||||
Total no. | 15,237,009.79 | 7,762 | 5.09 | 2,541,364 | 2,524,015 | 2,524,015 | |
MS score 1st quartile | 3,810,619.30 | 1,236 | 3.24 | 1 | 1 | 1 | |
MS score 2nd quartile | 3,809,710.03 | 1,702 | 4.47 | 1.38 (1.28–1.48) | 1.28 (1.18–1.37) | 1.25 (1.16–1.35) | |
MS score 3rd quartile | 3,809,099.26 | 2,021 | 5.31 | 1.64 (1.52–1.76) | 1.37 (1.27–1.48) | 1.30 (1.21–1.40) | |
MS score 4th quartile | 3,807,581.20 | 2,803 | 7.36 | 2.27 (2.12–2.43) | 1.72 (1.59–1.86) | 1.48 (1.36–1.60) | |
P for trend | <0.001 | <0.001 | <0.001 | ||||
Risk of myocardial infarction according to MS score quartiles | |||||||
Total no. | 15,233,494.65 | 8,197 | 5.38 | 2,541,364 | 2,524,015 | 2,524,015 | |
MS score 1st quartile | 3,810,834.06 | 990 | 2.60 | 1 | 1 | 1 | |
MS score 2nd quartile | 3,809,699.77 | 1,484 | 3.90 | 1.50 (1.38–1.63) | 1.35 (1.24–1.46) | 1.27 (1.17–1.38) | |
MS score 3rd quartile | 3,807,932.96 | 2,228 | 5.85 | 2.25 (2.09–2.43) | 1.79 (1.66–1.94) | 1.57 (1.46–1.70) | |
MS score 4th quartile | 3,805,027.86 | 3,495 | 9.19 | 3.54 (3.30–3.80) | 2.45 (2.26–2.66) | 1.89 (1.74–2.05) | |
P for trend | <0.001 | <0.001 | <0.001 |
Event | Model | MS indicator | AIC | AUC (95% CI) | P value |
---|---|---|---|---|---|
CV events | |||||
1 | ATP-III | 181,473.2 | 0.718 (0.714–0.722) | <0.001 | |
MS score | 181,292.2 | 0.720 (0.716–0.724) | |||
2 | ATP-III | 183,029.2 | 0.704 (0.700–0.708) | <0.001 | |
MS score | 182,600.6 | 0.708 (0.704–0.712) | |||
Stroke | |||||
1 | ATP-III | 100,892.9 | 0.705 (0.699–0.711) | 0.003 | |
MS score | 100,828.8 | 0.707 (0.701–0.712) | |||
2 | ATP-III | 101,508.2 | 0.693 (0.688–0.699) | 0.003 | |
MS score | 101,406.9 | 0.696 (0.690–0.702) | |||
MI | |||||
1 | ATP-III | 103,820.7 | 0.741 (0.735–0.746) | <0.001 | |
MS score | 103,696.9 | 0.743 (0.738–0.748) | |||
2 | ATP-III | 105,174.2 | 0.720 (0.714–0.725) | <0.001 | |
MS score | 104,813.0 | 0.726 (0.721–0.731) |
Values are presented as mean±standard deviation or number (%). MS, metabolic syndrome; BMI, body mass index; BP, blood pressure; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; ATP-III, Adult Treatment Program III.
Model 1: adjusted for age, body mass index, current smoking, heavy alcohol consumption, regular exercise, and family income; Model 2: model 1+further adjusted for the presence of hypertension, diabetes, medication for dyslipidemia, and total cholesterol. MS, metabolic syndrome; HR, hazard ratio; CI, confidence interval.
Model 1: adjusted for age, body mass index, current smoking, heavy alcohol consumption, regular exercise, and family income; Model 2: Model 1+further adjusted presence of hypertension, diabetes, medication for dyslipidemia, and total cholesterol. MS, metabolic syndrome; AIC, Akaike information criterion; AUC, the area under the receiver operating characteristic curve; CI, confidence interval; CV, cardiovascular; ATP-III, Adult Treatment Program III; MI, myocardial infarction. DeLong’s test for receiver operating characteristic (ROC) curves of two metabolic syndrome indicators.