J Korean Med Sci.  2022 May;37(18):e149. 10.3346/jkms.2022.37.e149.

Comparison of the Prevalence of Cardiometabolic Disorders and Comorbidities in Korea and the United States: Analysis of the National Health and Nutrition Examination Survey

• An S
• Ahn C
• Jang J
• Lee J
• Kang D
• Lee JK
• Park SK

• KMID: 2529715
• DOI: http://doi.org/10.3346/jkms.2022.37.e149

Abstract

Background
Comparison of the prevalence of cardiometabolic disorders (CMDs) and comorbidities in Korea and the United States (US) can be an important indicator for forecasting future risk of cardiovascular events in Korea. This study aimed to estimate and compare the prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, obesity, and metabolic syndrome (MetS) in Korea and the US.
Methods
A total of 15,872 individuals from the US National Health and Nutrition Examination Survey (NHANES) 2003–2014 and 26,492 from the Korea NHANES (KNHANES) 2007–2014 were included. Additionally, 164,339 (139,345 from the Health Examinees-Gem Study and 24,994 from the Cardiovascular Disease Association Study) participants enrolled in the Korea Genome and Epidemiology Study were included to investigate the differences of CMDs between urban and rural regions. To estimate the age-standardized prevalence of CMDs in individuals aged 40–69 years, direct standardization using the World Health Organization standard population was performed.
Results
The prevalence of CMDs was lower in Korea than the US (hypertension 49.9% vs.56.8%; DM 13.4% vs. 14.3%; hypercholesterolemia 16.8% vs. 17.8%; obesity 36.2% vs. 38.6%; and MetS 29.4% vs. 36.5%). According to the median survey years, dyslipidemia has become more prevalent in Korea than in the US since 2010. The prevalence of CMDs was greater in rural than that in urban areas in Korea.
Conclusion
The prevalence of dyslipidemia in Korea exceeded that of the US after 2010, which was associated with increasing burden of cardiovascular events. The present study suggests that further preventive strategies are needed to mitigate the prevalence of CMDs in Korea.

Keyword

Cardiometabolic Disorder; Prevalence; Epidemiology

Figure

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  Fig. 1 Combination of age-standard prevalence for comorbirity according to each studies. (A) US National Health and Nutrition Examination Survey, (B) Korea National Health and Nutrition Examination Survey, (C) Health Examinees-Gem Study, and (D) Cardiovascular Disease Association Study.

Reference

1. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390(10100):1151–1210. PMID: 28919116.

2. Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet. 2018; 392(10159):2052–2090. PMID: 30340847.

3. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019; 139(10):e56–528. PMID: 30700139.

4. Shin HY, Kim J, Lee S, Park MS, Park S, Huh S. Cause-of-death statistics in 2018 in the Republic of Korea. J Korean Med Assoc. 2020; 63(5):286–297.

5. Helfand M, Buckley D, Fleming C, Fu R, Freeman M, Humphrey L, et al. Screening for Intermediate Risk Factors for Coronary Heart Disease. Rockville, MD, USA: Agency for Healthcare Research and Quality (US);2009.

6. Kokubo Y, Iwashima Y. Higher blood pressure as a risk factor for diseases other than stroke and ischemic heart disease. Hypertension. 2015; 66(2):254–259. PMID: 26077565.

7. Laakso M. Cardiovascular disease in type 2 diabetes from population to man to mechanisms: the Kelly West Award Lecture 2008. Diabetes Care. 2010; 33(2):442–449. PMID: 20103560.

8. Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke. 2013; 44(7):1833–1839. PMID: 23704101.

9. Yaghi S, Elkind MS. Lipids and cerebrovascular disease: research and practice. Stroke. 2015; 46(11):3322–3328. PMID: 26451029.

10. Kirk EP, Klein S. Pathogenesis and pathophysiology of the cardiometabolic syndrome. J Clin Hypertens (Greenwich). 2009; 11(12):761–765. PMID: 20021538.

11. Emerging Risk Factors Collaboration. Di Angelantonio E, Kaptoge S, Wormser D, Willeit P, Butterworth AS, et al. Association of cardiometabolic multimorbidity with mortality. JAMA. 2015; 314(1):52–60. PMID: 26151266.

12. Licher S, Heshmatollah A, van der Willik KD, Stricker BH, Ruiter R, de Roos EW, et al. Lifetime risk and multimorbidity of non-communicable diseases and disease-free life expectancy in the general population: a population-based cohort study. PLoS Med. 2019; 16(2):e1002741. PMID: 30716101.

13. Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Murray CJ, et al. Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study. Circulation. 2014; 129(14):1483–1492. PMID: 24573352.

14. Kim HJ, Kim Y, Cho Y, Jun B, Oh KW. Trends in the prevalence of major cardiovascular disease risk factors among Korean adults: results from the Korea National Health and Nutrition Examination Survey, 1998-2012. Int J Cardiol. 2014; 174(1):64–72. PMID: 24742812.

15. Suh S, Lee MK. Metabolic syndrome and cardiovascular diseases in Korea. J Atheroscler Thromb. 2014; 21(Suppl 1):S31–S35. PMID: 24452115.

16. Lee SW, Kim HC, Lee HS, Suh I. Thirty-year trends in mortality from cardiovascular diseases in Korea. Korean Circ J. 2015; 45(3):202–209. PMID: 26023308.

17. Yoon YS, Oh SW. Recent shift of body mass index distribution in Korea: a population-based Korea National Health Insurance Database, 2002-2013. J Korean Med Sci. 2017; 32(3):434–438. PMID: 28145646.

18. Kim H, Kim S, Han S, Rane PP, Fox KM, Qian Y, et al. Prevalence and incidence of atherosclerotic cardiovascular disease and its risk factors in Korea: a nationwide population-based study. BMC Public Health. 2019; 19(1):1112. PMID: 31412823.

19. Muntner P, Hardy ST, Fine LJ, Jaeger BC, Wozniak G, Levitan EB, et al. Trends in blood pressure control among US adults with hypertension, 1999-2000 to 2017-2018. JAMA. 2020; 324(12):1190–1200. PMID: 32902588.

20. Johnson CL, Dohrmann SM, Burt VL, Mohadjer LK. National health and nutrition examination survey: sample design, 2011–2014. Vital Health Stat 2. 2014; (162):1–33.

21. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol. 2014; 43(1):69–77. PMID: 24585853.

22. Shin S, Lee HW, Kim CE, Lim J, Lee JK, Lee SA, et al. Egg consumption and risk of metabolic syndrome in Korean adults: results from the Health Examinees Study. Nutrients. 2017; 9(7):687.

23. Kim Y, Han BG. KoGES group. Cohort profile: the Korean Genome and Epidemiology Study (KoGES) consortium. Int J Epidemiol. 2017; 46(4):1350. PMID: 28938752.

24. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2018; 138(17):e484–e594. PMID: 30354654.

25. World Health Organization. International Diabetes Federation. Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia: Report of a WHO/IDF Consultation. Geneva, Switzerland: World Health Organization;2006.

26. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106(25):3143–3421. PMID: 12485966.

27. World Health Organization Regional Office for the Western Pacific. The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Sydney, Australia: Health Communications Australia;2000.

28. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, et al. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract. 2007; 75(1):72–80. PMID: 16735075.

29. Boyle P, Parkin DM. Cancer registration: principles and methods. Statistical methods for registries. IARC Sci Publ. 1991; (95):126–158. PMID: 1894318.

30. Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJ, Lozano R, Inoue M. Age Standardization of Rates: A New WHO Standard. GPE Discussion Paper Series: No. 31. Geneva, Switzerland: World Health Organization;2001.

31. Anand SS, Hawkes C, de Souza RJ, Mente A, Dehghan M, Nugent R, et al. Food consumption and its impact on cardiovascular disease: importance of solutions focused on the globalized food system: a report from the workshop convened by the World Heart Federation. J Am Coll Cardiol. 2015; 66(14):1590–1614. PMID: 26429085.

32. Rigotti NA, Clair C. Managing tobacco use: the neglected cardiovascular disease risk factor. Eur Heart J. 2013; 34(42):3259–3267. PMID: 24014389.

33. Hackshaw A, Morris JK, Boniface S, Tang JL, Milenković D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018; 360:j5855. PMID: 29367388.

34. Whitman IR, Agarwal V, Nah G, Dukes JW, Vittinghoff E, Dewland TA, et al. Alcohol abuse and cardiac disease. J Am Coll Cardiol. 2017; 69(1):13–24. PMID: 28057245.

35. Goenka S, Lee IM. Physical activity lowers mortality and heart disease risks. Lancet. 2017; 390(10113):2609–2610. PMID: 28943265.

36. Shiroma EJ, Lee IM. Physical activity and cardiovascular health: lessons learned from epidemiological studies across age, gender, and race/ethnicity. Circulation. 2010; 122(7):743–752. PMID: 20713909.

37. Clark D 3rd, Colantonio LD, Min YI, Hall ME, Zhao H, Mentz RJ, et al. Population-attributable risk for cardiovascular disease associated with hypertension in black adults. JAMA Cardiol. 2019; 4(12):1194–1202. PMID: 31642869.

38. World Health Organization. Noncommunicable Diseases Country Profiles 2018. Geneva, Switzerland: World Health Organization;2018.

39. World Health Organization. Global Action Plan for the Prevention and Control of NCDs 2013–2020. Geneva, Switzerland: World Health Organization;2013.

40. Willey JZ, Moon YP, Kahn E, Rodriguez CJ, Rundek T, Cheung K, et al. Population attributable risks of hypertension and diabetes for cardiovascular disease and stroke in the northern Manhattan study. J Am Heart Assoc. 2014; 3(5):e001106. PMID: 25227406.

41. Nilsson PM, Nilsson JA, Berglund G. Population-attributable risk of coronary heart disease risk factors during long-term follow-up: the Malmö Preventive Project. J Intern Med. 2006; 260(2):134–141. PMID: 16882277.

42. Glazer NL, Smith NL, Heckbert SR, Doggen CJ, Lemaitre RN, Psaty BM. Risk of myocardial infarction attributable to elevated levels of total cholesterol among hypertensives. Am J Hypertens. 2005; 18(6):759–766. PMID: 15925732.

43. Sugiyama D, Okamura T, Watanabe M, Higashiyama A, Okuda N, Nakamura Y, et al. Risk of hypercholesterolemia for cardiovascular disease and the population attributable fraction in a 24-year Japanese cohort study. J Atheroscler Thromb. 2015; 22(1):95–107. PMID: 25185893.

44. Nordestgaard BG, Varbo A. Triglycerides and cardiovascular disease. Lancet. 2014; 384(9943):626–635. PMID: 25131982.

45. Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011; 123(20):2292–2333. PMID: 21502576.

46. Houtkooper RH, Williams RW, Auwerx J. Metabolic networks of longevity. Cell. 2010; 142(1):9–14. PMID: 20603007.

47. Jun S, Ha K, Chung S, Joung H. Meat and milk intake in the rice-based Korean diet: impact on cancer and metabolic syndrome. Proc Nutr Soc. 2016; 75(3):374–384. PMID: 26975473.

48. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016; 387(10027):1513–1530. PMID: 27061677.

49. Srikanth S, Deedwania P. Management of dyslipidemia in patients with hypertension, diabetes, and metabolic syndrome. Curr Hypertens Rep. 2016; 18(10):76. PMID: 27730495.

50. Song Y, Joung H. A traditional Korean dietary pattern and metabolic syndrome abnormalities. Nutr Metab Cardiovasc Dis. 2012; 22(5):456–462. PMID: 21215606.

51. Cross SH, Mehra MR, Bhatt DL, Nasir K, O’Donnell CJ, Califf RM, et al. Rural-urban differences in cardiovascular mortality in the US, 1999-2017. JAMA. 2020; 323(18):1852–1854. PMID: 32396176.

52. Lee HY. Socioeconomic disparities in the prevalence, diagnosis, and control of hypertension in the context of a universal health insurance system. J Korean Med Sci. 2017; 32(4):561–567. PMID: 28244279.

53. Chung SJ, Han YS, Lee SI, Kang SH. Urban and rural differences in the prevalence of gender and age specific obesity and related health behaviors in Korea. J Korean Med Sci. 2005; 20(5):713–720. PMID: 16224141.