Exposure-weighted scoring for metabolic syndrome and the risk of myocardial infarction and stroke: a nationwide populati
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ORIGINAL INVESTIGATION
Cardiovascular Diabetology Open Access
Exposure‑weighted scoring for metabolic syndrome and the risk of myocardial infarction and stroke: a nationwide population‑based study Eun Young Lee1, Kyungdo Han2, Da Hye Kim3, Yong‑Moon Park4, Hyuk‑Sang Kwon5, Kun‑Ho Yoon1,6, Mee Kyoung Kim5* and Seung‑Hwan Lee1,6*
Abstract Background: Metabolic syndrome (MetS) status changes over time, but few studies have investigated the relation‑ ship 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 20 min of strenuous physical activity ≥ 3/week or > 30 min of moderate physical activity ≥ 5/week. Household income was dichotomized at the lower 25%. Blood was drawn after overnight fasting for the measurement of serum glucose, total cholesterol, triglyceride, high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol levels. Estimated glomerular filtration rate was calculated using the modification of diet in renal disease formula: 186 × (serum creatinine)−1.154 × age−0.203 × 0.742 (if female). Hospitals performing health check-ups were certified by the NHIS and received regular quality control. Diabetes mellitus was diagnosed as at least one claim per year with International Classification of Disease, 10th Revision (ICD-10) codes E10–14 and the prescription of anti-diabetic medication, or fasting glucose level ≥ 126 mg/dL. Hypertension was diagnosed as at least one claim per year with ICD-10 codes I10 or I11 and the prescription of anti-hypertensive agents, or systolic/diastolic BP ≥ 140/90 mmHg. Dyslipidemia was diagnosed as at least one claim per year with ICD-10 code E78 and the prescription of a lipid-lowering agent or a total cholesterol level ≥ 240 mg/dL. MetS was defined according to the revised criteria of the National Cholesterol Education Program–Adult Treatment Panel III [21] and included the modified WC
Lee et al. Cardiovasc Diabetol
(2020) 19:153
criteria for abdominal obesity of the Korean Society for the Study of Obesity [22]. MetS was diagnosed if at least t
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