Pre-Metabolic Syndrome and Incidence of Type 2 Diabetes and Hypertension: From the Korean Genome and Epidemiology Study

Abstract

The aim of this study was to investigate the prevalence of premetabolic syndrome (pre-MetSyn) and its components and to longitudinally examine their association with new-onset type 2 diabetes (T2D) or hypertension. A total of 4037 men and 4400 women aged 40 to 69 years were selected from the Korean Genome and Epidemiology Study, observed from 2001 to 2014. Pre-MetSyn was defined as the presence of one or two components of MetSyn (B, elevated blood pressure; G, elevated glucose; H, low HDL-cholesterol; T, elevated triglycerides; W, increased waist circumference). The prevalence of pre-MetSyn was higher than that of non-MetSyn and MetSyn in both men and women. In multivariate Cox regression analyses, G, T, G+T, W+G, B+G, B+T, W+T, B+H, and H+T in men and G, T, G+H, B+T, and H+T in women were significantly associated with new-onset T2D. B, W, B+H, B+T, W+H, and W+T in men and B, B+T, B+H, B+W, and W+H in women were significantly associated with new-onset hypertension. The prevalence of pre-MetSyn components and their associations with new-onset T2D or hypertension differed according to sex and disease. Our results suggest that specific phenotypes of pre-MetSyn may be important factors for predicting and preventing the development of T2D and hypertension.

Keywords: cohort study; hypertension; metabolic syndrome; pre-metabolic syndrome; type 2 diabetes mellitus.

Figure 1

This is a figure. Schemes follow the same formatting. (A) prevalence in men, (B) prevalence in women. Grey bars indicate the prevalence of subjects with no MetSyn components (i.e., non-MetSyn patients). Green bars represent the prevalence of subjects with only one MetSyn component (B, W, G, H, or T). Blue bars represent the prevalence of subjects with a specific component plus one other MetSyn component. Brown bars represent the prevalence of subjects with a specific component plus two or more other MetSyn components (i.e., MetSyn patients). Numbers located above the bars indicate the numerical prevalence values. B, elevated blood pressure; G, elevated glucose; H, low HDL-cholesterol; KoGES, Korean Genome and Epidemiology Study Ansan and Ansung; MetSyn, metabolic syndrome; T, elevated triglycerides; W, increased waist circumference.

Figure 2

Prevalence of each MetSyn component, combinations of two MetSyn components, and MetSyn. (A) prevalence in men, (B) prevalence in women. Numbers located above the bars represent the numerical prevalence values. All groups are mutually exclusive; thus, the sum of prevalences was 100%. Colors for each component and combination are the same as those used in Figure 3 and Figure 4 to facilitate visual comparisons. B, elevated blood pressure; G, elevated glucose; H, low HDL-cholesterol; KoGES, Korean Genome and Epidemiology Study Ansan and Ansung; MetSyn, metabolic syndrome; T, elevated triglycerides; W, increased waist circumference.

Figure 3

Adjusted hazard ratios and 95% confidence intervals for new-onset type2 diabetes. (A,C) men, (B,D) women. (A,B) Hazard ratios and 95% confidence intervals for the risk of new-onset type 2 diabetes of each single MetSyn component and two-component combination, compared with non-MetSyn, based on multivariate Cox regression analysis after adjusting for age, body mass index, smoking, and alcohol intake. Closed circles represent adjusted hazard ratios, and short vertical bars indicate the lower and upper limits of the 95% confidence interval for new-onset type 2 diabetes. (C,D) Adjusted hazard ratios for new-onset type 2 diabetes when setting the rows (black color; e.g., T, H+T, B]) and columns (red color; e.g., G+T, W+G, B+G) as reference and comparison groups, respectively. Of the 105 possible unique comparisons (based on a 15 × 15 matrix), adjusted hazard ratios are shown for only those comparisons with a Bonferroni-corrected p-value < 4.79 × 10⁻⁴ (=0.05/105). * p < 0.05, ** p < 0.01, *** p < 0.001. B, elevated blood pressure; G, elevated glucose; H, low HDL-cholesterol; KoGES, Korean Genome and Epidemiology Study Ansan and Ansung; MetSyn, metabolic syndrome; T, elevated triglycerides; T2D, type 2 diabetes; W, increased waist circumference.

Figure 4

Adjusted hazard ratios and 95% confidence intervals for new-onset hypertension. (A,C) men, (B,D) women. (A,B) Hazard ratios and 95% confidence intervals for the risk of new-onset hypertension of each single MetSyn component and two-component combination, compared with non-MetSyn, based on multivariate Cox regression analysis after adjusting for age, body mass index, smoking, and alcohol intake. Closed circles represent adjusted hazard ratios, and short vertical bars indicate the lower and upper limits of the 95% confidence interval for new-onset hypertension. (C,D) Adjusted hazard ratios for new-onset hypertension when setting the rows (black color; e.g., B+H, G, T]) and columns (red color; e.g., B+H, B, B+T) as reference and comparison groups, respectively. Of the 105 possible unique comparisons (based on a 15 × 15 matrix), adjusted hazard ratios are shown for only those comparisons with a Bonferroni-corrected p-value < 4.79 × 10⁻⁴ (=0.05/105). * p < 0.05, ** p < 0.01, *** p < 0.001. B, elevated blood pressure; G, elevated glucose; H, low HDL-cholesterol; HTN, hypertension; KoGES, Korean Genome and Epidemiology Study Ansan and Ansung; MetSyn, metabolic syndrome; T, elevated triglycerides; W, increased waist circumference.