한국인 폐경여성에서 대사증후군이 심장병 사망에 미치는 영향
The Infl uence on Cardiovascular Mortality of the Metabolic Syndrome in Korean Postmenopausal Women
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연구목적: 폐경 여성에서 대사증후군 환자들이 심장병 사망률에 미치는 영향을 알아보기 위함이다. 연구재료 및 방법: 서울시 대사증후군 연구 사업단은 1994년도부터 2004년까지 전국 18개 지역 대학병원 및 병원의 건강검진센터를 방문한 과거 심혈관 질환이 없는 40세 이상의 폐경 여성 24,949명을 대상으로 하였다. 대사증후군 여부에 따른 기본 분석은 평균과 표준편차, 백분율을 분석하였다. 대사증후군 여부에 따른 특성의 차이는 t 검정 혹은 X2 검정을 실시하였다. 대사증후군과 관련 있는 검사수치들 간의 관련성을 이해하고자 상관분석을 실시하였다. 대사증후군 여부에 따른 심장병 생존율의 차이를 보고자 Life-table 분석과 log-rank 검정을 실시하였다. 심장병 사망에 대한 대사증후군 여부, 대사증후군 요소의 수 증가에 따른 영향을 보고자 Cox proportional hazard model 분석을 실시하였다. 결과: 대사증후군이 없는 폐경 여성에 비해 대사증후군이 있는 폐경 여성에서 연령이 더 높고 더 비만하였으며고지혈증, 고혈당 등의 특징적인 양상을 나타내었다. 연령, 흡연 및 음주력을 통제한 후 심장병 사망률에 영향을 미치는 대사증후군의 요소는 공복 혈당이었다 (비교위험도 2.5, 95% 신뢰구간 1.2-5.3). 대사증후군의 요소가 증가할수록 심혈관 사망에 미치는 영향이 증가하여 대사증후군의 요소가 한 개 이하인 군에 비해 대사증후군 요소가 4개 있는 군에서 심장병 발생위험이 4.2배, 5개 가진 군에서 7.3배 높았다. 또한 대사증후군이 없는폐경 여성에 비해 대사증후군이 있는 폐경 여성에서 심장병 생존율이 낮았다. 결론: 폐경 여성에서 대사증후군이 심혈관 사망률을 증가시킨다. 대사증후군의 요소 중 연령과 흡연이 심장병사망과 연관이 있었으며 두 가지 요소를 통제하였을 때 대사증후군 요소 중 고혈당이 심장병 사망을 유의하게증가시켰다. 대사증후군의 요소의 증가에 따른 심장병 사망률도 증가함을 알 수 있었다. 대사증후군의 요소 및수에 따른 심장병 사망에 대한 연구가 더 필요하며 또한 대사증후군의 요소의 치료 및 예방으로 심장병 사망위험을 낮출 수 있는 지에 대한 대규모 중제연구도 이루어져야 한다.
Abstract
Objectives: Metabolic syndrome components, insulin resistance and central obesity cause type 2 diabetes and hypertension. This will increase the risk of cardiovascular disease. Women after menopause are at increased risk of metabolic syndrome. Several researchers studied that in menopause, metabolic syndrome increased cardiovascular mortality. We studied the impact on cardiovascular mortality of postmenopausal women with metabolic syndrome in the Republic of Korea. Methods: Twenty four thousand nine hundred forty nine postmenopausal women aged 40 years or older were enrolled at health promotion centers of national university hospital located in 18 regions during 1994-2004. Age, weights, height, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), cholesterol, triglyceride (TG),high-density lipoprotein were evaluated and history taking about alcohol consumption, smoking, and exercise was performed. In addition, subjects who died of cardiac disease were analyzed from January 1995 to December 2009. Results: Metabolic syndrome was higher in postmenopausal women with increased in age, BMI, blood pressure (BP), FBG,cholesterol, TG. Thirty cardiac deaths occurred during the observation period. Factors affecting cardiac death were age, smoking,FBG and when age and smoking were controlled. FBG was an important factor affecting cardiovascular mortality in our study. When controlling age, smoking, and alcohol consumption, metabolic syndrome caused an increased relative risk of cardiovascular mortality. Survival rate was much lower in postmenopausal women with metabolic syndrome than those without metabolic syndrome. Conclusion: Metabolic syndrome in Korean postmenopausal women increased cardiovascular mortality.
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