title: Metabolic syndrome predicts long-term mortality in subjects without established diabetes mellitus in asymptomatic Korean population: A propensity score matching analysis from the Korea Initiatives on Coronary Artery Calcification (KOICA) registry.
abstract: Despite the different features of diabetes mellitus (DM) in Asian populations compared with Western populations, the impact of metabolic syndrome (MetS) on long-term mortality according to DM status has not yet been elucidated in the Asian population.After performing 1:1 propensity score matching (PSM) using clinical variables including age, gender, smoking, and individual MetS components between DM and non-DM subjects from the data of the Korea Initiatives on Coronary Artery Calcification registry, mortality was evaluated according to DM and MetS in 14,956 asymptomatic Korean subjects.The mean follow-up duration was 53.1 months (interquartile range: 33-80). The overall prevalence of MetS was 60%. DM subjects had higher mortality compared with non-DM subjects (1.2% vs 0.7%, respectively; P = 0.001); the cumulative mortality by Kaplan-Meier analysis was higher in DM subjects than in non-DM subjects (log-rank P = 0.001). DM increased the risk of mortality in PSM participants (hazard ratio [HR] 1.74; P = 0.001). In non-DM subjects, MetS (HR 2.32) and one of its components, central obesity (HR 1.97), were associated with an increased risk of mortality (both P < 0.05). In contrast, there was no significant difference in the risk of mortality according to MetS or its components in DM subjects. After adjusting for confounding risk factors, it was shown that MetS independently increased the risk of mortality in non-DM subjects.Compared with non-DM subjects, DM subjects have an increased risk of long-term mortality among PSM participants. MetS appears to have an independent impact on mortality in subjects without established DM among the asymptomatic Korean population. Our results may not be applicable to the whole subjects with MetS because the PSM using MetS components was performed between subjects with and without DM which was very high risk for adverse clinical events.
authors.affiliation: Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan Severance Biomedical Science Institute Department of Internal Medicine, Yonsei Cardiovascular Center, Yonsei University College of Medicine Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Department of Internal Medicine, Seoul National University Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Ki-Bum
authors.initials: KB
authors.lastname: Won
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.forename: Donghee
authors.initials: D
authors.lastname: Han
authors.forename: Jidong
authors.initials: J
authors.lastname: Sung
authors.forename: Su-Yeon
authors.initials: SY
authors.lastname: Choi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000401:mortality* / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D024821:Metabolic Syndrome / Q000401:mortality* / Q000503:physiopathology; D008875:Middle Aged; D011237:Predictive Value of Tests; D057216:Propensity Score; D016016:Proportional Hazards Models; D012016:Reference Values; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis