LONG-TERM IMPACT OF METABOLIC SYNDROME MANAGEMENT ON MORTALITY IN PATIENTS WITH ATRIAL FIBRILLATION

초록

Background: It is still unclear whether the degree of metabolic syndrome (MetS) management is associated with all-cause mortality in patients with AF. Objective: The aim of our study was to determine the impact of the management of metabolic syndrome on mortality in patients with AF. Methods: This study included 5,585 consecutive AF patients (≥19 years, mean age 66 ± 13 years, 41.1% female) in a tertiary hospital from 2007 to January 2017. Patients were divided into three groups by degree of Mets management ; well-controlled MetS [Group 1, n=330, patients who had optimal controls of metabolic factors with improved HbA1c, LDL and weight loss of 10% more], not-well controlled MetS [Group 2, n=171, one or two optimal control of metabolic factors], and poorly-controlled MetS [Group 3, n=107, suboptimal control of all metabolic factors]. Results: MetS was observed in 608 (10.9%) patients. The mean duration follow-up was 77 ± 42 months. There were no significant differences in age (p=0.190), sex (p=0.690), body mass index (p=0.152) and baseline HbA1c (p=0.937) and LDL (p=0.421) among three each groups. Group 3 had significant lower Kaplan-Meier survival free of all-cause mortality than other groups (p<0.001). In Cox proportional-hazards models adjusted by relevant risk factors, age (HR=1.03, 95% CI: 1.02-1.05, p<0.001) and poorly-controlled MetS (HR=2.44, 95% CI: 1.40- 4.24, p<0.001) showed significant association with increased mortality in AF patients. Conclusion: Our data suggest that aggressive strategies for targeting poorly controlled Mets including optimal management of metabolic factors would be needed for long-term survival benefit in AF patients.