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Epidemiology and Health 2022;e2022078.
DOI: https://doi.org/10.4178/epih.e2022078    [Accepted] Published online Sep 21, 2022.
The association between metabolic syndrome and heart failure in middle-aged men and women : population-based study of 2 million individuals
Tae-Eun Kim1  , Hyeongsu Kim2  , JiDong Sung3  , Duk-Kyung Kim3  , Myoung-Soon Lee4  , Seong Woo Han5  , Hyun-Joong Kim6  , Sung Hea Kim6  , Kyu-Hyung Ryu5 
1Department of Clinical Pharmacology, Konkuk University Medical Center, Seoul, Korea, Seoul, Korea
2Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea, Seoul, Korea
3Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Seoul, Korea
4Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon-si, Korea, Seoul, Korea
5Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea, Seoul, Korea
6Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea, Seoul, Korea
Correspondence  Sung Hea Kim ,Email: shkim@kuh.ac.kr
Kyu-Hyung Ryu ,Email: shkim@kuh.ac.kr
Received: Jul 4, 2022  Accepted after revision: Sep 21, 2022
Although the association between metabolic syndrome (MetS) and heart failure (HF) risk is known, large longitudinal studies are limited. In this study, we investigated metabolic status as a risk factor for HF in middle-aged men and women and considered sex differences in various risk factors for HF using nationwide real-world data.
Data obtained from the Korean National Health Insurance Service from 2009 to 2016 were analyzed. A total of 2151597 middle-age subjects (between 50 and 59 years old) were enrolled. Subjects were divided into three groups (normal, Pre‐MetS and MetS). Cox proportional hazard models were used to estimate the association between MetS and incident HF after adjusting for clinical risk factors.
At baseline, MetS existed in 23,77% of men and 10.58% of women. Pre-MetS and MetS increased the risk of HF: the hazard ratio (95% confidence interval) of pre-MetS was 1.508 (1.287-1.767) in men and 1.395 (1.158-1.681) in women; the hazard ratio (95% confidence interval) of MetS was 1.711 (1.433-2.044) in men and 2.144 (1.674-2.747) in women. Current smoking, low hemoglobin level, underweight (BMI<18.5) and high creatinine level as well as acute myocardial infarction were also predictors of HF in both men and women.
This study confirmed that pre-MetS and MetS are risk factors for HF in middle-aged men and women. The effect of MetS on the occurrence of HF was stronger in women than in men. Pre-MetS was also a predictor of HF but was associated with a lower risk than MetS.
Keywords: metabolic syndrome; heart failure; big data; gender difference


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