Youngnam Bok, Jae-Hyung Roh, Soo Yeon An, Seon-Ah Jin, Jun Hyung Kim, Hyung Joon Joo, Jung-Woo Son, Sung Hea Kim, Seonghoon Choi, Seongwoo Han, Mi-Seung Shin, Eung Ju Kim, Jin-Ok Jeong
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We investigated the association of fatty liver index (FLI) with incident hypertension and CVD outcomes in a large cohort of adults with suboptimal BP.</p><p><strong>Methods: </strong>We included 179,028 Koreans with suboptimal BP and no traditional risk factors from the National Health Insurance Service-National Sample Cohort, who underwent health examinations between 2009 and 2014. All subjects were divided into two groups based on their BP: 'normal BP' group (systolic BP [SBP] 120-129, diastolic BP [DBP] 80-84 mmHg), and 'high-normal BP' group (SBP 130-139, DBP 85-89 mmHg). The incidences of new-onset hypertension and major adverse cardiac and cerebrovascular events (MACCEs) were analyzed in the two groups across quartiles. Multivariate Cox proportional hazards regression analysis assessed the association between the FLI and primary outcome.</p><p><strong>Results: </strong>During a median follow-up of 8.3 years, 34,667 participants (19.36%) developed new-onset hypertension, which was significantly greater in the 'high-normal BP' group than in the 'normal BP' group (25.95% vs. 14.25%, <i>P</i> < 0.001). The incidence of new-onset hypertension was significantly higher in participants with higher FLIs according to the FLI quartile values in both groups. Additionally, 3,339 (1.87%) MACCEs were observed during the follow-up period. MACCEs occurred more frequently in the 'high-normal BP' group than in the 'normal BP group' (2.33% vs. 1.51%, <i>P</i> < 0.001). MACCEs were also associated with FLI quartiles. In the multivariable models adjusted for potential confounders, the hazard ratio for MACCEs comparing the highest vs. lowest quartiles of the FLI was 1.640 (95% confidence interval [CI], 1.409-1.910) and 1.363 (95% CI, 1.141-1.627) in the 'high-normal BP' group and 'normal BP' group, respectively.</p><p><strong>Conclusion: </strong>Over 8-9 years, 19.3% of Korean adults with suboptimal BP developed hypertension, and 1.87% experienced MACCEs without traditional risk factors. A higher FLI was independently associated with the development of hypertension and MACCEs. The FLI may be an important predictor of new-onset hypertension and adverse cardiovascular outcomes.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 26","pages":"e135"},"PeriodicalIF":2.3000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235195/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prognostic Significance of Fatty Liver Index for the Development of Hypertension and Cardiovascular Events in Populations With Suboptimal Blood Pressure.\",\"authors\":\"Youngnam Bok, Jae-Hyung Roh, Soo Yeon An, Seon-Ah Jin, Jun Hyung Kim, Hyung Joon Joo, Jung-Woo Son, Sung Hea Kim, Seonghoon Choi, Seongwoo Han, Mi-Seung Shin, Eung Ju Kim, Jin-Ok Jeong\",\"doi\":\"10.3346/jkms.2025.40.e135\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Suboptimal blood pressure (BP) is a precursor to clinical hypertension and is associated with BP-related morbidity and mortality. Non-alcoholic fatty liver disease, a metabolic disorder with an increasing incidence rate, is associated with cardiovascular diseases (CVDs). We investigated the association of fatty liver index (FLI) with incident hypertension and CVD outcomes in a large cohort of adults with suboptimal BP.</p><p><strong>Methods: </strong>We included 179,028 Koreans with suboptimal BP and no traditional risk factors from the National Health Insurance Service-National Sample Cohort, who underwent health examinations between 2009 and 2014. All subjects were divided into two groups based on their BP: 'normal BP' group (systolic BP [SBP] 120-129, diastolic BP [DBP] 80-84 mmHg), and 'high-normal BP' group (SBP 130-139, DBP 85-89 mmHg). The incidences of new-onset hypertension and major adverse cardiac and cerebrovascular events (MACCEs) were analyzed in the two groups across quartiles. Multivariate Cox proportional hazards regression analysis assessed the association between the FLI and primary outcome.</p><p><strong>Results: </strong>During a median follow-up of 8.3 years, 34,667 participants (19.36%) developed new-onset hypertension, which was significantly greater in the 'high-normal BP' group than in the 'normal BP' group (25.95% vs. 14.25%, <i>P</i> < 0.001). The incidence of new-onset hypertension was significantly higher in participants with higher FLIs according to the FLI quartile values in both groups. Additionally, 3,339 (1.87%) MACCEs were observed during the follow-up period. MACCEs occurred more frequently in the 'high-normal BP' group than in the 'normal BP group' (2.33% vs. 1.51%, <i>P</i> < 0.001). MACCEs were also associated with FLI quartiles. In the multivariable models adjusted for potential confounders, the hazard ratio for MACCEs comparing the highest vs. lowest quartiles of the FLI was 1.640 (95% confidence interval [CI], 1.409-1.910) and 1.363 (95% CI, 1.141-1.627) in the 'high-normal BP' group and 'normal BP' group, respectively.</p><p><strong>Conclusion: </strong>Over 8-9 years, 19.3% of Korean adults with suboptimal BP developed hypertension, and 1.87% experienced MACCEs without traditional risk factors. A higher FLI was independently associated with the development of hypertension and MACCEs. 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引用次数: 0
摘要
背景:亚理想血压(BP)是临床高血压的前兆,与BP相关的发病率和死亡率相关。非酒精性脂肪性肝病是一种发病率越来越高的代谢性疾病,与心血管疾病(cvd)有关。我们研究了一大批血压不达标的成年人中,脂肪肝指数(FLI)与高血压和心血管疾病结局的关系。方法:我们从国家健康保险服务-国家样本队列中纳入了179028名血压不佳且没有传统危险因素的韩国人,他们在2009年至2014年期间接受了健康检查。所有受试者根据其血压分为两组:“正常血压”组(收缩压[SBP] 120-129,舒张压[DBP] 80-84 mmHg)和“高正常血压”组(收缩压[SBP] 130-139, DBP 85-89 mmHg)。分析两组新发高血压和主要不良心脑血管事件(MACCEs)的发生率。多变量Cox比例风险回归分析评估了FLI与主要结局之间的关系。结果:在8.3年的中位随访期间,34,667名参与者(19.36%)出现了新发高血压,“高正常血压”组明显高于“正常血压”组(25.95%比14.25%,P < 0.001)。根据两组的FLI四分位数值,FLI高的参与者新发高血压的发生率明显更高。此外,在随访期间观察到3339例(1.87%)MACCEs。MACCEs在“高正常血压组”中的发生率高于“正常血压组”(2.33% vs. 1.51%, P < 0.001)。MACCEs也与FLI四分位数相关。在针对潜在混杂因素进行调整的多变量模型中,比较FLI最高和最低四分位数的MACCEs风险比在“高正常血压”组和“正常血压”组分别为1.640(95%可信区间[CI], 1.409-1.910)和1.363 (95% CI, 1.141-1.627)。结论:在8-9年的时间里,19.3%的血压亚优成人发生了高血压,1.87%的人经历了无传统危险因素的MACCEs。较高的FLI与高血压和MACCEs的发展独立相关。FLI可能是新发高血压和不良心血管结局的重要预测指标。
Prognostic Significance of Fatty Liver Index for the Development of Hypertension and Cardiovascular Events in Populations With Suboptimal Blood Pressure.
Background: Suboptimal blood pressure (BP) is a precursor to clinical hypertension and is associated with BP-related morbidity and mortality. Non-alcoholic fatty liver disease, a metabolic disorder with an increasing incidence rate, is associated with cardiovascular diseases (CVDs). We investigated the association of fatty liver index (FLI) with incident hypertension and CVD outcomes in a large cohort of adults with suboptimal BP.
Methods: We included 179,028 Koreans with suboptimal BP and no traditional risk factors from the National Health Insurance Service-National Sample Cohort, who underwent health examinations between 2009 and 2014. All subjects were divided into two groups based on their BP: 'normal BP' group (systolic BP [SBP] 120-129, diastolic BP [DBP] 80-84 mmHg), and 'high-normal BP' group (SBP 130-139, DBP 85-89 mmHg). The incidences of new-onset hypertension and major adverse cardiac and cerebrovascular events (MACCEs) were analyzed in the two groups across quartiles. Multivariate Cox proportional hazards regression analysis assessed the association between the FLI and primary outcome.
Results: During a median follow-up of 8.3 years, 34,667 participants (19.36%) developed new-onset hypertension, which was significantly greater in the 'high-normal BP' group than in the 'normal BP' group (25.95% vs. 14.25%, P < 0.001). The incidence of new-onset hypertension was significantly higher in participants with higher FLIs according to the FLI quartile values in both groups. Additionally, 3,339 (1.87%) MACCEs were observed during the follow-up period. MACCEs occurred more frequently in the 'high-normal BP' group than in the 'normal BP group' (2.33% vs. 1.51%, P < 0.001). MACCEs were also associated with FLI quartiles. In the multivariable models adjusted for potential confounders, the hazard ratio for MACCEs comparing the highest vs. lowest quartiles of the FLI was 1.640 (95% confidence interval [CI], 1.409-1.910) and 1.363 (95% CI, 1.141-1.627) in the 'high-normal BP' group and 'normal BP' group, respectively.
Conclusion: Over 8-9 years, 19.3% of Korean adults with suboptimal BP developed hypertension, and 1.87% experienced MACCEs without traditional risk factors. A higher FLI was independently associated with the development of hypertension and MACCEs. The FLI may be an important predictor of new-onset hypertension and adverse cardiovascular outcomes.
期刊介绍:
The Journal of Korean Medical Science (JKMS) is an international, peer-reviewed Open Access journal of medicine published weekly in English. The Journal’s publisher is the Korean Academy of Medical Sciences (KAMS), Korean Medical Association (KMA). JKMS aims to publish evidence-based, scientific research articles from various disciplines of the medical sciences. The Journal welcomes articles of general interest to medical researchers especially when they contain original information. Articles on the clinical evaluation of drugs and other therapies, epidemiologic studies of the general population, studies on pathogenic organisms and toxic materials, and the toxicities and adverse effects of therapeutics are welcome.