Mortality associated with Metabolic Syndrome in people with COPD managed in primary care

Urvee Karsanji; Rachael A Evans; Jennifer K Quint; Kamlesh Khunti; Claire A Lawson; Emily Petherick; Neil J Greening; Sally J Singh; Matthew Richardson; Michael C Steiner

doi:10.1183/23120541.00211-2022

Abstract

Objective The prevalence of Metabolic Syndrome (MetS) has been reported to be higher in selected populations of people with COPD. The impact of MetS on mortality in COPD is unknown. We used routinely collected healthcare data to estimate the prevalence of MetS in people with COPD managed in primary care and determine its impact on 5-year mortality.

Methods Records from 103 955 patients with COPD from the Clinical Practice Research Datalink (CPRD-GOLD) between 2009 to 2017 were scrutinised. MetS was defined as the presence of three or more of: obesity, hypertension, lowered HDL cholesterol, elevated triglycerides or type 2 diabetes mellitus (T2DM). Univariate and multivariable Cox regression models were constructed to determine the prognostic impact of MetS on 5-year mortality. Similar univariate models were constructed for individual components of the definition of MetS.

Results The prevalence of MetS in the COPD cohort was 10.1%. Univariate analyses showed the presence of MetS increased mortality (HR 1.19, 95% CI:1.12–1.27, p<0.001) but this risk was substantially attenuated in the multivariable analysis (HR 1.06, 95% CI:0.99–1.13, p=0.085). The presence of hypertension (HR 1.70, 95% CI:1.63–1.77, p<0.001) and T2DM (HR 1.41, 95% CI:1.34–1.48, p<0.001) increased and obesity (HR 0.74, 95% CI:0.71–0.78, p<0.001) reduced mortality risk.

Conclusion MetS in patients with COPD is associated with higher 5-year mortality but this impact was minimal when adjusted for indices of COPD disease severity and other comorbidities. Individual components of the MetS definition exerted differential impacts on mortality suggesting limitation to the use of MetS as a multicomponent condition in predicting outcome in COPD.

Footnotes

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Conflict of interest: Rachael Evans has received grants or contracts from NIHR / UKRI, outside the submitted work. Speaker fee received from Boeringher, outside the submitted work. Support for attending meetings received from Chiesi, outside the submitted work. Leadership or fiduciary role in other board, society, committee or advocacy group: ERS Group 01.02 Pulmonary Rehabilitation Secretary, unpaid, outside the submitted work.

Conflict of interest: Neil Greening has received grants or contracts from GlaxoSmithKline and Genentech, outside the submitted work. Consulting fees received from Genentech, outside the submitted work. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events received from AstraZeneca, Chiesi and GlasxoSmithKline, outside the submitted work. Member of Data Safety Monitoring Committee for Thirty Respiratory Limited, outside the submitted work.

Conflict of interest: Michael C Steiner has received support for the present manuscript from National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM) and the NIHR Leicester Biomedical Research Centre (BRC).

Conflict of interest: Kamlesh Khunti has received grants or contracts from Boehringer Ingelheim, AstraZeneca, Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, outside the submitted work. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Amgen, Astrazeneca, Bayer, NAPP, Lilly, Merck Sharp and Dohme, Novartis, Novo Nordisk, Roche, Berlin-Chemie AG/Menarini Group, Sanofi-Aventis, Servier, Boehringer Ingelheim, outside the submitted work.

Conflict of interest: Jennifer Quint has received grants or contracts from The Health Foundation, MRC, GSK, Bayer, BI, AUK-BLF, HDR UK, Chiesi and AZ, outside the submitted work. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, received from GlaxoSmithKline, Boehringer Ingelheim, AstraZeneca, Chiesi, Insmed and Bayer, outside the submitted work.

Conflict of interest: The remaining authors have nothing to disclose.

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