P6619Long-term impact of metabolic syndrome management on mortality in patients with atrial fibrillation

Background: Metabolic syndrome (MetS) is known to be associated with atrial fibrillation (AF) and cardiovascular mortality. However, it is still unclear whether the degree of Mets management is associated with all-cause mortality in patients with AF. Purpose: The aim of our study was to determine the impact of the management of metabolic syndrome on mortality in patients with AF during long-term follow-up. 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. The MetS was defined as diabetes plus any 2 other metabolic factors including hypertension, diabetes, dyslipidemia, and overweight. 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 glycosylated hemoglobin (HbA1c), Low-density lipoprotein (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 [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. AF patients with MetS had significantly higher all-cause mortality compared to them without MetS (6.4% vs. 4.5%, p=0.029). There were no significant differences in age (p=0.190), sex (p=0.690), body mass index (p=0.152) and baseline laboratory test including 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=1.034, 95% CI: 1.018–1.050, p<0.001) and poorly-controlled MetS (HR=2.436, 95% CI: 1.401–4.236, p<0.001) showed significant association with increased mortality in AF patients. Conclusions: 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.