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. 2022 Oct 24;8(4):00211-2022.
doi: 10.1183/23120541.00211-2022. eCollection 2022 Oct.

Mortality associated with metabolic syndrome in people with COPD managed in primary care

Urvee Karsanji  1 , Rachael A Evans  1 , Jennifer K Quint  2 , Kamlesh Khunti  3 , Claire A Lawson  3   4 , Emily Petherick  5 , Neil J Greening  1 , Sally J Singh  1 , Matthew Richardson  1 , Michael C Steiner  1
Affiliations

Mortality associated with metabolic syndrome in people with COPD managed in primary care

Urvee Karsanji et al. ERJ Open Res. .

Abstract

Objective: The prevalence of metabolic syndrome (MetS) has been reported to be higher in selected populations of people with COPD. The impact of MetS on mortality in COPD is unknown. We used routinely collected healthcare data to estimate the prevalence of MetS in people with COPD managed in primary care and determine its impact on 5-year mortality.

Methods: Records from 103 955 patients with COPD from the Clinical Practice Research Datalink (CPRD-GOLD) between 2009 to 2017 were scrutinised. MetS was defined as the presence of three or more of: obesity, hypertension, lowered high-density lipoprotein cholesterol, elevated triglycerides or type 2 diabetes mellitus (T2DM). Univariate and multivariable Cox regression models were constructed to determine the prognostic impact of MetS on 5-year mortality. Similar univariate models were constructed for individual components of the definition of MetS.

Results: The prevalence of MetS in the COPD cohort was 10.1%. Univariate analyses showed the presence of MetS increased mortality (hazard ratio (HR) 1.19, 95% CI: 1.12-1.27, p<0.001), but this risk was substantially attenuated in the multivariable analysis (HR 1.06, 95% CI: 0.99-1.13, p=0.085). The presence of hypertension (HR 1.70, 95% CI: 1.63-1.77, p<0.001) and T2DM (HR 1.41, 95% CI: 1.34-1.48, p<0.001) increased and obesity (HR 0.74, 95% CI: 0.71-0.78, p<0.001) reduced mortality risk.

Conclusion: MetS in patients with COPD is associated with higher 5-year mortality, but this impact was minimal when adjusted for indices of COPD disease severity and other comorbidities. Individual components of the MetS definition exerted differential impacts on mortality suggesting limitation to the use of MetS as a multicomponent condition in predicting outcome in COPD.

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Conflict of interest statement

Conflict of interest: R.A. Evans has received grants or contracts from National Institute for Health Research (NIHR)/UKRI, a speaker fee from Boehringer, support for attending meetings from Chiesi; and she is ERS Group 01.02 Pulmonary Rehabilitation Secretary (unpaid), all outside the submitted work. J.K. Quint has received grants or contracts from The Health Foundation, MRC, GSK, Bayer, BI, AUK-BLF, HDR UK, Chiesi and AZ; and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from GlaxoSmithKline, Boehringer Ingelheim, AstraZeneca, Chiesi, Insmed and Bayer, all outside the submitted work. K. Khunti has received grants or contracts from Boehringer Ingelheim, AstraZeneca, Novartis, Novo Nordisk, Sanofi-Aventis, Lilly and Merck Sharp & Dohme; and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Amgen, AstraZeneca, Bayer, NAPP, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Roche, Berlin-Chemie AG/Menarini Group, Sanofi-Aventis, Servier and Boehringer Ingelheim, and outside the submitted work. N.J. Greening has received grants or contracts from GlaxoSmithKline and Genentech; consulting fees from Genentech; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, Chiesi and GlaxoSmithKline; and served on a Data Safety Monitoring Committee for Thirty Respiratory Limited, all outside the submitted work. M.C. Steiner has received support for the present manuscript from NIHR Applied Research Collaboration East Midlands and the NIHR Leicester Biomedical Research Centre. The remaining authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Flowchart identifying the cohort of COPD patients used to apply the components of the metabolic syndrome (MetS) definition using complete case analysis for the components of MetS and disease predictors: Medical Research Council (MRC) score, forced expiratory volume in 1 s (FEV1) % predicted and body mass index (BMI). The variables FEV1 % predicted, BMI and MRC grade each had over 25% missingness, hence were excluded from the cohort and full-case analysis was used leaving a generous sample of n=40 806 patients. CPRD: Clinical Practice Research Datalink; HES: Hospital Episode Statistics; ONS: Office for National Statistics; IMD: Index of Multiple Deprivation.
FIGURE 2
FIGURE 2
The association of the presence of metabolic syndrome (MetS) with all-cause mortality. KM: Kaplan–Meier.
FIGURE 3
FIGURE 3
Kaplan–Meier (KM) survival curves showing survival probability by component of metabolic syndrome (MetS) definition: obesity, high-density lipoprotein (HDL) status, triglyceride status (TG), hypertension and type 2 (T2) diabetes mellitus.
See this image and copyright information in PMC

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