Metabolic syndrome severity score for predicting cardiovascular events: A nationwide population-based study from Korea

Huh Ji Hye; Wonjin Kim; Kang Jun Goo; Lee Seong Jin; Sung-Hee Ihm

doi:10.1530/endoabs.70.AEP297

Background and aims: Recently, a metabolic syndrome severity score (MS score) using a dataset of the Korea National Health and Nutrition Examination Surveys has been developed. We aimed to determine whether the newly developed score is a significant predictor of cardiovascular (CV) events among the Korean population.

Methods: From the Korean National Health Insurance System, 2,541,364 (aged 40–59 years) subjects with no history of CV events (ischemic stroke or myocardial infarction [MI]), who underwent health examinations from 2009–2011 and were followed up until 2014–2017, were identified. Cox proportional hazard model was employed to investigate the association between MS score and CV events. Model performance of MS score for predicting CV events was compared to that of conventional metabolic syndrome diagnostic criteria (ATP-III) using the Akaike information criterion and the area under the receiver operating characteristic curve.

Results: Over a median follow-up of 6 years, 15,762 cases of CV events were reported. MS score at baseline showed a linear association with incident CV events. In themultivariable-adjusted model, the hazard ratios (95% confidence intervals) comparing the highest vs lowest quartiles of MS score were 1.48 (1.36–1.60) for MI and 1.89 (1.74–2.05) forstroke. Model fitness and performance of the MS score in predicting CV events were superior to those of ATP-III (Table 1).

**Table 1** Model fit analysis and model performance of metabolic syndrome indicators.
Event	Model	MS indicator	AIC	AUC (95% CI)	P-value^*
CV events
	1	ATP-III	181,473.2	0.718 (0.714–0.722)	<0.001
		MS score	181,292.2	0.720 (0.716–0.724)
	2	ATP-III	183,029.2	0.704 (0.700–0.708)	<0.001
		MS score	182,600.6	0.708 (0.704–0.712)
Stroke
	1	ATP-III	100,892.9	0.705 (0.699–0.711)	0.003
		MS score	100,828.8	0.707 (0.701–0.712)
	3	ATP-III	101,508.2	0.693 (0.688–0.699)	0.003
		MS score	101,406.9	0.696 (0.690–0.702)
MI
	1	ATP-III	103,820.7	0.741 (0.735–0.746)	<0.001
		MS score	103,696.9	0.743 (0.738–0.748)
	3	ATP-III	105,174.2	0.720 (0.714–0.725)	<0.001
		MS score	104,813.0	0.726 (0.721–0.731)
Model 1: adjusted for age, body mass index, current smoking, heavy alcohol consumption, regular exercise, and family income
Model 2: Model 1+ further adjusted presence of hypertension, diabetes, medication for dyslipidemia, and total cholesterol.
^*P-value: DeLong’s test for ROC curves of two metabolic syndrome indicators.

Conclusions: The newly developed age- and sex-specific continuous MS score for the Korean population is an independent predictor of ischemic stroke and MI in Korean middle-aged adults even after adjusting for confounding factors.

Endocrine Abstracts

AEP297