Figures
- FIGURE 1
Flowchart identifying the cohort of COPD patients used to apply the components of the metabolic syndrome (MetS) definition using complete case analysis for the components of MetS and disease predictors: Medical Research Council (MRC) score, forced expiratory volume in 1 s (FEV1) % predicted and body mass index (BMI). The variables FEV1 % predicted, BMI and MRC grade each had over 25% missingness, hence were excluded from the cohort and full-case analysis was used leaving a generous sample of n=40 806 patients. CPRD: Clinical Practice Research Datalink; HES: Hospital Episode Statistics; ONS: Office for National Statistics; IMD: Index of Multiple Deprivation.
- FIGURE 2
The association of the presence of metabolic syndrome (MetS) with all-cause mortality. KM: Kaplan–Meier.
- FIGURE 3
Kaplan–Meier (KM) survival curves showing survival probability by component of metabolic syndrome (MetS) definition: obesity, high-density lipoprotein (HDL) status, triglyceride status (TG), hypertension and type 2 (T2) diabetes mellitus.
Tables
- TABLE 1
Baseline characteristics for the population defined by the presence of metabolic syndrome (MetS)
All MetS Non-MetS Subjects n 40 806 4141 36 665 Sex Male 22 165 (54.32) 2421 (58.46) 19 744 (53.85) Female 18 641 (45.68) 1720 (41.54) 16 921 (46.15) Ethnicity Black 196 (0.48) 23 (0.56) 173 (0.47) Mixed other 216 (0.53) 22 (0.53) 194 (0.53) South Asian 416 (1.02) 70 (1.69) 346 (0.94) Unknown 1742 (4.27) 55 (1.33) 1687 (4.60) White 38 236 (93.70) 3971 (95.89) 34 265 (93.45 Age years, mean±sd 68.69±10.74 68.92±9.60 68.66±10.87 35–44 675 (1.65) 49 (1.18) 626 (1.71) 45–54 3659 (8.97) 281 (6.79) 3378 (9.21) 55–64 9431 (23.11) 973 (23.50) 8458 (23.07) 65–74 14 228 (34.87) 1597 (38.57) 12 631 (34.45) 75+ 12 813 (31.40) 1241 (29.97) 11 572 (31.56) BMI kg·m−2, mean±sd 27.56±6.02 34.10±5.66 26.82±5.60 Underweight (<18.5) 1546 (3.79) 6 (0.14) 1540 (4.20) Normal (18.5–24.9) 13 168 (32.27) 169 (4.08) 12 999 (35.45) Overweight (25–29.9) 13 719 (33.62) 474 (11.45) 13 245 (36.12) Obese (30–39.9) 10 929 (26.78) 2926 (70.66) 8003 (21.83) Severely obese (≥40) 1444 (3.54) 566 (13.67) 878 (2.39) Smoking status Current smoker 14 532 (35.61) 1147 (27.70) 13 385 (36.51) Nonsmoker/never 4544 (11.14) 501 (12.10) 4043 (11.03) Ex-smoker 21 011 (51.49) 2448 (59.12) 18 563 (50.63) Missing 719 (1.76) 45 (1.09) 674 (1.84) Index of multiple deprivation 1=least deprived 6331 (15.51) 559 (13.50) 5772 (15.74) 2 7581 (18.58) 684 (16.52) 6897 (18.81) 3 7797 (19.11) 771 (18.62) 7026 (19.16) 4 9152 (22.43) 950 (22.94) 8202 (22.37) 5=most deprived 9945 (24.37) 1177 (28.42) 8768 (23.91) FEV1 % predicted, mean±sd 63.11±22.76 64.25±20.56 62.98±23.00 Number of exacerbations in previous year 0 26 773 (65.61) 2678 (64.67) 24 095 (65.72) 1 9191 (22.52) 912 (22.02) 8279 (22.58) 2 3005 (7.36) 342 (8.26) 2663 (7.26) 3 1086 (2.66) 118 (2.85) 968 (2.64) 4 395 (0.97) 51 (1.23) 344 (0.94) 5 212 (0.52) 26 (0.63) 186 (0.51) 6 89 (0.22) 11 (0.27) 78 (0.21) 7+ 55 (0.13) 3 (0.07) 52 (0.14) MRC dyspnoea score 1=least severe 7928 (19.43) 568 (13.72) 7360 (20.07) 2 16 688 (40.90) 1458 (35.21) 15 230 (41.54) 3 10 161 (24.90) 1191 (28.76) 8970 (24.46) 4 5173 (12.68) 793 (19.15) 4380 (11.95) 5=most severe 856 (2.10) 131 (3.16) 725 (1.98) GOLD, n (%) I 8577 (21.02) 837 (20.21) 7740 (21.11) II 19 776 (48.46) 2248 (54.29) 17 528 (47.81) III 10 150 (24.87) 935 (22.58) 9215 (25.13) IV 2303 (5.64) 121 (2.92) 2182 (5.95) Components of MetS definition Obesity (BMI at least 30) 12 373 (30.32) 3492 (84.33) 8881 (24.22) Hypertension 14 846 (36.38) 3515 (84.88) 11 331 (30.90) HDL (<40 mg·dL−1 (men); <50 mg·dL−1 (women)) 6231 (15.27) 2862 (69.11) 3369 (9.19) TG (>150 mg·dL−1) 595 (1.46) 418 (10.09) 177 (0.48) T2DM 6967 (17.07) 3255 (78.60) 3712 (10.12) Comorbidities Liver disease 982 (2.41) 196 (4.73) 786 (2.14) Kidney disease 5845 (14.32) 1049 (25.33) 4796 (13.08) Psychological disease 4258 (10.43) 554 (13.38) 3704 (10.10) Frailty 1514 (3.71) 229 (5.53) 1285 (3.50) Asthma 16 315 (39.98) 1886 (45.54) 14 429 (39.35) CVD 7416 (18.17) 1415 (34.17) 6001 (16.37) Musculoskeletal 8972 (21.99) 1316 (31.78) 7656 (20.88) GERD 3581 (8.78) 471 (11.37) 3110 (8.48) Categorical data presented as n (%) unless otherwise indicated. BMI: body mass index; FEV1: forced expiratory volume in 1 s; MRC: Medical Research Council; GOLD: Global Initiative for Chronic Obstructive Lung Disease; HDL: high-density lipoprotein; TG: triglyceride; T2DM: type 2 diabetes mellitus; CVD: cardiovascular disease; GERD: gastroesophageal reflux disorder.
- TABLE 2
Multiple associations using the odds ratio (OR) between disease and demographic variables and the presence of metabolic syndrome (MetS)
Variable OR p-value genderFemale ref. genderMale 1.20 <0.001 age 0.98 <0.001 ethnicityWhite ref. ethnicityBlack 1.15 0.551 ethnicityMixed_Other 0.99 0.970 ethnicitySouth Asian 1.70 <0.001 ethnicityUnknown 0.43 <0.001 smokingNon ref. smokingEx 1.05 0.337 smokingCurrent 0.68 <0.001 smokingMissing 0.58 <0.001 imd1 ref. imd2 1.00 0.947 imd3 1.09 0.156 imd4 1.15 0.137 imd5 1.32 <0.001 fev1pp 1.00 <0.001 n_exacs 0.96 0.027 mrc1 ref. mrc2 1.21 <0.001 mrc3 1.57 <0.001 mrc4 2.02 <0.001 mrc5 1.97 <0.001 liver 1.74 <0.001 kidney 1.79 <0.001 psych 1.15 0.006 frail 1.32 <0.001 asthma 1.16 <0.001 cvd 2.22 <0.001 mskel 1.51 <0.001 gerd 1.08 0.139 Variables highlighted in bold are associated with the presence of MetS.
- TABLE 3
Hazard ratios (HRs) for all-cause mortality for the presence of metabolic syndrome and individual components
Variable HR (95% CI) p-value mets 1.19 (1.12–1.27) <0.001 obese 0.74 (0.71–0.78) <0.001 hyp 1.70 (1.63–1.77) <0.001 lowhdl 1.00 (0.95–1.06) 0.885 hightg 0.83 (0.69–0.99) 0.041 diabetesT2 1.41 (1.34–1.48) <0.001 Variables highlighted in bold are associated with 5-year all-cause mortality.
- TABLE 4
Multivariable hazard ratio (HR) model between adjustment variables and 5-year all-cause mortality
Variable HR (95% CI) p-value mets=0 ref - mets=1 1.06 (0.99–1.13) 0.085 genderFemale ref - genderMale 1.33 (1.27–1.38) <0.001 age 1.07 (1.07–1.07) <0.001 ethnicityWhite ref - ethnicityBlack 0.63 (0.42–0.93) 0.020 ethnicityMixed_Other 0.70 (0.55–0.90) 0.005 ethnicitySouth Asian 0.99 (0.70–1.41) 0.970 ethnicityUnknown 0.84 (0.72–0.97) 0.020 smokingNon ref - smokingEx 1.17 (1.10–1.26) <0.001 smokingCurrent 1.75 (1.62–1.89) <0.001 smokingMissing 1.16 (1.00–1.35) 0.044 imd1 ref - imd2 1.05 (0.98–1.12) 0.190 imd3 1.06 (0.99–1.14) 0.102 imd4 1.05 (0.98–1.12) 0.193 imd5 1.13 (1.05–1.20) <0.001 fev1pp 0.99 (0.99–0.99) <0.001 n_exacs 1.08 (1.06–1.10) <0.001 mrc1 ref - mrc2 1.21 (1.12–1.29) <0.001 mrc3 1.53 (1.42–1.64) <0.001 mrc4 1.89 (1.75–2.04) <0.001 mrc5 2.88 (2.57–3.22) <0.001 liver 1.53 (1.36–1.72) <0.001 kidney 1.25 (1.19–1.32) <0.001 psych 1.41 (1.32–1.51) <0.001 frail 1.26 (1.15–1.38) <0.001 asthma 0.93 (0.89–0.97) <0.001 cvd 1.44 (1.37–1.51) <0.001 mskel 1.02 (0.98–1.07) 0.350 gerd 0.99 (0.91–1.06) 0.700 Variables highlighted in bold are associated with 5-year all-cause mortality.
- TABLE 5
Stratified multivariable survival model on 5-year all-cause mortality by the presence of metabolic syndrome
Adjusted for Variable HR (95% CI) p-value Demographics mets=1 1.17 (1.10–125) <0.001 IMD mets=1 1.19 (1.12–1.27) <0.001 COPD severity mets=1 1.13 (1.02–1.25) 0.021 Comorbidities mets=1 0.95 (0.89–1.01) 0.100 HR: hazard ratio; IMD: Index of Multiple Deprivation. Variables highlighted in bold are associated with 5-year all-cause mortality.
Supplementary Material
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Supplementary material 00211-2022.SUPPLEMENT
