Risk of Cardiovascular Events Associated with Chronic Obstructive Pulmonary Disease and/or Metabolic Syndrome: A Large-Scale Nationwide Population-Based Cohort Study

Figures & data

Figure 1 Study design, criteria for inclusion and exclusion, and groups of participants.

Abbreviations: COPD, chronic obstructive pulmonary disease; MetS, metabolic syndrome; +, disease exists; ‒, disease does not exist.

Table 1 Demographic Data of Study Participants

Variable	COPD				P-value
	Yes N = 170,338		No N = 4,931,472
	Metabolic Syndrome
	Yes N = 44,362	No N = 125,976	Yes N = 1,193,014	No N = 3,738,458
Female (%)	21,992(49.6)	58,122(46.1)	477,355(40.0)	1,882,871(50.4)	< 0.0001
Age, years (%)					< 0.0001
40–49	5,285(11.9)	22,176(17.6)	407,777(34.2)	1,658,067(44.4)
50–59	11,762(26.5)	34,390(27.3)	405,922(34.0)	1,205,019(32.2)
60–69	16,168(36.5)	40,506(32.2)	269,563(22.6)	636,716(17.0)
70–79	10,034(22.6)	25,651(20.4)	101,309(8.5)	219,000(5.9)
80–89	1092(2.5)	3184(2.5)	8268(0.7)	19,113(0.5)
>90	21(0.1)	69(0.1)	175(0.0)	543(0.0)
Height, cm	160.4±9.2	160.6±8.6	163.3±9.2	161.9±8.6	< 0.0001
Weight, kg	66.6±10.6	59.6±9.3	69.5±11.1	61.3±9.5	< 0.0001
BMI, kg/m^2	25.8±3.1	23.1±2.9	26.0±4.1	23.3±2.9	< 0.0001
Smoking status					< 0.0001
Never (%)	27,738(63.0)	77,787(62.1)	658,472(55.6)	2,396,550(64.6)
Former (%)	7285(16.5)	21,267(17.0)	223,586(18.9)	583,522(15.7)
Current (%)	9038(20.5)	26,127(20.9)	303,230(25.6)	732,823(19.7)
Alcohol status (per week, %)					< 0.0001
Never	23,847(64.7)	80,452(64.7)	606,522(51.5)	2,082,101(56.5)
1	5301(12.1)	16,761(13.5)	202,640(17.2)	703,094(19.1)
2	3756(8.6)	10,174(8.2)	159,121(13.5)	422,284(11.5)
3	2740(6.3)	7003(5.6)	107,457(9.1)	249,543(6.8)
4	1034(2.4)	2493(2.0)	36,596(3.1)	80,931(2.2)
5	841(1.9)	2135(1.7)	26,787(2.3)	58,489(1.6)
6	576(1.3)	1589(1.3)	14,428(1.2)	32,270(0.9)
7	1189(2.7)	3674(3.0)	24,517(2.1)	58,584(1.6)
MetS components
Waist circumference, cm	88.0±8.8	80.1±8.4	87.3±9.0	79.0±8.2	< 0.0001
TG, mg/dL	194.7±111.0	116.0±69.1	207.2±122.5	117.2±73.6	< 0.0001
Total cholesterol, mg/dL	204.5±48.0	194.4±40.0	206.0±122.5	197.7±39.7	< 0.0001
HDL-C, mg/dL	50.0±34.0	58.9±39.3	49.2±31.6	58.5±34.7	< 0.0001
LDL-C, mg/dL	120.0±83.0	119.3±81.4	119.7±91.8	120.2±86.6	0.4788
SBP, mmHg	131.7±15.8	123.1±14.7	131.3±15.5	121.2±14.2	< 0.0001
DBP, mmHg	81.3±10.3	75.8±9.4	82.1±10.4	75.5±9.5	< 0.0001
Fasting serum glucose, mg/dL	109.9±30.6	95.9±19.5	110.9±32.3	95.4±19.7	< 0.0001

Abbreviations: COPD, chronic obstructive pulmonary disease; BMI, body mass index; MetS, metabolic syndrome; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; SBP, systolic blood pressure; DBP, diastolic blood pressure; SD, standard deviation.

Table 2 Incidence and Hazard Ratios of Cardiovascular Events, All-Cause Mortality, and Cardiovascular Mortality Adjusted for Age, Sex, Smoking Status, and Alcohol Consumption for Participants Grouped by the Presence of COPD and MetS

Variable	No. (%)	Incidence Rate/1000 Person-Years	Hazard Ratio (95% CI)			P-value
			Crude	Model 1^†	Model 2^‡
Cardiovascular event
COPD‒/MetS‒	438,477(11.7)	11.1	1	1	1	< 0.001
COPD‒/MetS+	220,682(18.5)	20.4	2.032(2.484–2.545)	1.775(1.765–1.784)	1.770(1.760–1.779)
COPD+/MetS‒	27,593(21.9)	24.9	2.514(2.021–2.043)	1.662(1.642–1.683)	1.645(1.625–1.666)
COPD+/MetS+	12,698(28.6)	35.4	3.777(3.711–3.845)	2.386(2.344–2.429)	2.368(2.326–2.411)
All-cause mortality
COPD‒/MetS‒	158,219(4.2)	3.9	1	1	1	< 0.001
COPD‒/MetS+	72,471(6.1)	6.4	2.120(2.101–2.140)	1.756(1.740–1.772)	1.743(1.727–1.759)
COPD+/MetS‒	19,490(15.5)	17.0	5.482(5.400–5.565)	2.633(2.594–2.674)	2.557(2.518–2.597)
COPD+/MetS+	6620(14.9)	17.0	6.254(6.101–6.410)	3.004(2.930–3.079)	2.932(2.860–3.007)
Cardiovascular mortality
COPD‒/MetS‒	25,212(0.7)	1.2	1	1	1	< 0.001
COPD‒/MetS+	13,606(1.1)	1.4	2.567(2.512–2.624)	2.067(2.023–2.112)	2.058(2.014–2.104)
COPD+/MetS‒	2773(2.2)	1.5	5.012(4.818–5.214)	2.215(2.128–2.306)	2.144(2.059–2.232)
COPD+/MetS+	1161(2.6)	1.5	7.146(6.734–7.582)	3.050(2.874–3.237)	2.968(2.795–3.152)

Notes: ^†Model 1: additionally adjusted for age and sex. ^‡Model 2: model 1 + additionally adjusted for smoking status and alcohol consumption.

Abbreviations: COPD, chronic obstructive pulmonary disease; MetS, metabolic syndrome; CV, cardiovascular; No, number of events; +, disease exists; ‒, disease does not exist.

Figure 2 Kaplan–Meier survival analysis. (A) Cumulative CV events. (B) All-cause mortality. (C) Cardiovascular mortality.

Abbreviations: CV, cardiovascular; COPD, chronic obstructive pulmonary disease; +, disease exists; ‒, disease does not exist.

Data Sharing Statement

Data were obtained from the National Health Information Database (NHID) and are available at http://nhiss.nhis.or.kr (accessed December 31, 2022). NHID allows access to all these data for any researcher who adheres to the research ethics at some cost. Those seeking access to this article’s data can download it from the website after providing consent to follow the research ethics.