MOESM1 of Mortality and causes of death in a national sample of type 2 diabetic patients in Korea from 2002 to 2013

Additional file 1. Additional tables

MOESM1 of Improved trends in cardiovascular complications among subjects with type 2 diabetes in Korea: a nationwide study (2006–2013)

Additional file 1: Table S1. Study participants (Korean NHIS beneficiaries aged ≥ 30 years) distributed by age and gender

Table1_Predictive value of the Framingham steatosis index for cardiovascular risk: a nationwide population-based cohort study.docx

BackgroundNon-alcoholic fatty liver disease (NAFLD) is common and is associated with cardiovascular (CV) disease and mortality. The Framingham steatosis index (FSI) was recently proposed as a diagnostic marker of NAFLD and was calculated from age, body mass index, triglyceride, aspartate aminotransferase, alanine aminotransferase, diabetes history, and hypertension status. We aimed to evaluate the predictive ability of FSI for CV risk using a large-scale population dataset from the Korean National Health Insurance Service–National Health Screening Cohort (NHIS–HEALS).MethodsAmong 514,866 individuals in the NHIS–HEALS, we excluded those who died, had a history of admission due to a CV event, and were heavy drinkers. The final study cohort comprised 283,427 participants. We employed both unadjusted and covariate-adjusted models in Cox proportional hazards regression analyses to determine the association between FSI and major adverse cardiovascular events (MACEs), CV events, and CV mortality.ResultsDuring a median follow-up of 5.9 years, we documented 9,674, 8,798, and 1,602 cases of MACEs, CV events, and CV mortality, respectively. The incidence of MACEs was 1.28%, 2.99%, 3.94%, and 4.82% in the first to fourth quartiles of FSI, respectively. The adjusted hazard ratios (95% confidence interval) for MACEs gradually and significantly increased with the FSI quartiles [1.302 (1.215–1.395) in Q2, 1.487 (1.390–1.590) in Q3, and 1.792 (1.680–1.911) in Q4], following an adjustment for conventional CV risk factors, including age, sex, smoking, drinking, physical activities, low-density lipoprotein cholesterol, estimated glomerular filtration rate, and waist circumference. Participants in the higher quartiles of FSI exhibited a noteworthy increase in the occurrence of CV event. However, upon adjusting for relevant risk factors, the association between FSI and CV mortality did not reach statistical significance.ConclusionOur study suggests that the FSI, which is a surrogate marker of NAFLD, has a prognostic value for detecting individuals at higher risk of CV events.</p

Trends in the prevalence of metabolic syndrome and its components in South Korea: Findings from the Korean National Health Insurance Service Database (2009–2013)

<div><p>Background</p><p>The prevalence of metabolic syndrome has markedly increased worldwide. However, studies in the United States show that it has remained stable or slightly declined in recent years. Whether this applies to other countries is presently unclear.</p><p>Objectives</p><p>We examined the trends in the prevalence of metabolic syndrome and its components in Korea.</p><p>Methods</p><p>The prevalence of metabolic syndrome and its components was estimated in adults aged >30 years from the Korean National Health Insurance Service data from 2009 to 2013. The revised National Cholesterol Education Program criteria were used to define metabolic syndrome.</p><p>Results</p><p>Approximately 10 million individuals were analyzed annually. The age-adjusted prevalence of metabolic syndrome increased from 28.84% to 30.52%, and the increasing trend was more prominent in men. Prevalence of hypertriglyceridemia, low HDL-cholesterol, and impaired fasting plasma glucose significantly increased. However, the prevalence of hypertension decreased in both genders. The prevalence of abdominal obesity decreased in women over 50 years-of-age but significantly increased in young women and men (<50 years).</p><p>Conclusions</p><p>The prevalence of metabolic syndrome is still increasing in Korea. Trends in each component of metabolic syndrome are disparate according to the gender, or age groups. Notably, abdominal obesity among young adults increased significantly; thus, interventional strategies should be implemented particularly for this age group.</p></div

Relative risks (RRs) and 95% confidence intervals (CI) for incident type 2 diabetes based on serum ferritin quartile categories during a 4 year period.

<p>Model 1: adjusted for age, HbA1c, WC, systolic BP, diastolic BP, drinking, smoking, exercise habits, and family history of diabetes.</p><p>Model 2: adjusted for variables in Model 1 plus hsCRP.</p><p>Model 3: adjusted for variables in Model 1 plus GGT, AST and ALT.</p><p>Model 4: adjusted for variables in Model 1 plus TG, HDL-C, LDL-C, and HOMA-IR.</p><p>Model 5: adjusted for overall confounders noted above.</p

Selection of study participants.

<p>Selection of study participants.</p

2013 ACC/AHA versus 2004 NECP ATP III Guidelines in the Assignment of Statin Treatment in a Korean Population with Subclinical Coronary Atherosclerosis

<div><p>Background</p><p>The usefulness of the 2013 ACC/AHA guidelines for the management of blood cholesterol in the Asian population remains controversial. In this study, we investigated whether eligibility for statin therapy determined by the 2013 ACC/AHA guidelines is better aligned with the presence of subclinical coronary atherosclerosis detected by CCTA (coronary computed tomography angiography) compared to the previously recommended 2004 NCEP ATP III guidelines.</p><p>Methods</p><p>We collected the data from 5,837 asymptomatic subjects who underwent CCTA using MDCT during routine health examinations. Based on risk factor assessment and lipid data, we determined guideline-based eligibility for statin therapy according to the 2013 ACC/AHA and 2004 NCEP ATP III guidelines. We defined the presence and severity of subclinical coronary atherosclerosis detected in CCTA according to the presence of significant coronary artery stenosis (defined as >50% stenosis), plaques, and the degree of coronary calcification.</p><p>Results</p><p>As compared to the 2004 ATP III guidelines, a significantly higher proportion of subjects with significant coronary stenosis (61.8% vs. 33.8%), plaques (52.3% vs. 24.7%), and higher CACS (CACS >100, 63.6% vs. 26.5%) was assigned to statin therapy using the 2013 ACC/AHA guidelines (<i>P</i> < .001 for all variables). The area under the curves of the pooled cohort equation of the new guidelines in detecting significant stenosis, plaques, and higher CACS were significantly higher than those of the Framingham risk calculator.</p><p>Conclusions</p><p>Compared to the previous ATP III guidelines, the 2013 ACC/AHA guidelines were more sensitive in identifying subjects with subclinical coronary atherosclerosis detected by CCTA in an Asian population.</p></div

Forest plots of the ORs and CIs of components of metabolic syndrome (2013 versus 2009).

<p>BP = blood pressure, CI = confidence interval, HDL = high-density lipoprotein, OR = odds ratio.</p

Characteristics of Korean adults who participated in regular health check-ups, between 2009 and 2013.

<p>Characteristics of Korean adults who participated in regular health check-ups, between 2009 and 2013.</p

Baseline clinical and biochemical characteristics of study subjects with respect to incident diabetes during a 4 year period.

<p>BMI, body mass index; WC, waist circumference; BP, blood pressure; FPG, fasting plasma glucose; HbA1c, hemoglobin A1c; HOMA-IR, homeostasis model of insulin resistance; TG, triglycerides; LDL-C, low density lipoprotein-cholesterol; HDL-C, high density lipoprotein-cholesterol; AST, aspartate aminotransferase; AST, alanine aminotransferase; GGT, gamma-glutamyltransferase; hsCRP, high sensitive C-reactive protein.</p>a<p>Represented in the following order; ≤3 times/week, ≥4 times/week.</p>b<p>Represented in the following order; ≤2 times/week, ≥3 times/week.</p