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1 저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할수없습니다. 변경금지. 귀하는이저작물을개작, 변형또는가공할수없습니다. 귀하는, 이저작물의재이용이나배포의경우, 이저작물에적용된이용허락조건을명확하게나타내어야합니다. 저작권자로부터별도의허가를받으면이러한조건들은적용되지않습니다. 저작권법에따른이용자의권리는위의내용에의하여영향을받지않습니다. 이것은이용허락규약 (Legal Code) 을이해하기쉽게요약한것입니다. Disclaimer

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8 CONTENTS V

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10 Table 1. General Characteristics of the Study Participants at Baseline by Exposure Status... Table 2. Characteristics of Overall Cardiovascular Disease... Table 3. Characteristics of Each Cardiovascular Disease... Table 4. Risks of Cardiovascular Diseases Related to Exposure by Each Model... Table 5. Estimates of Sarcopenic Obesity and Covariates for CVD in Model 3... Table 6. Association of Sarcopenia, Obesity, and Sarcopenic Obesity with CVD in the Male... Table 7. Association of Sarcopenia, Obesity, and Sarcopenic Obesity with CVD in the Female... Table 8. Association of Sarcopenia, Obesity, and Sarcopenic Obesity with CVD in the Middle-aged Group (40-59)... Table 9. Association of Sarcopenia, Obesity, and Sarcopenic Obesity with CVD in the Older Group (60-69)... VII

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21 IRB No. E1608/ ).

33 Table 1. General Characteristics of the Study Participants at Baseline by Exposure Status Characteristics Normal Sarcopenia Obesity Sarcopenic Obesity N=2790 N=2798 N=3869 N=238 (28.8%) (28.9%) (40.0%) (2.3%) P-value Sociodemographic Factor Female, n (%) 1337 (47.9) 1440 (51.5) 2200 (56.7) 132 (58.4) <.0001 Age, mean SD ± ± ± 8.4 <.0001 Age group, n (%) (27.9) 817 (29.2) 1003 (25.8) 24 (10.6) (20.6) 525 (18.8) 893 (23.0) 33 (14.6) (13.1) 339 (12.1) 542 (14.0) 32 (14.2) (11.9) 324 (11.6) 548 (14.1) 35 (15.5) (13.4) 379 (13.6) 509 (13.1) 50 (20.1) (13.1) 414 (14.8) 386 (10.0) 52 (23.0) <.0001 Spouse, n (%) Yes 2502 (90.4) 2501 (90.0) 3446 (89.3) 189 (86.7).2222 Education, n (%) <6 y 919 (33.3) 855 (30.8) 1343 (34.9) 83 (37.2) 6 y, <12 y 1517 (55.0) 1528 (55.0) 1991 (51.7) 109 (48.9) y 322 (11.7) 397 (14.3) 520 (13.5) 31 (13.9) Income, n (%) Low 1041 (38.0) 947 (34.4) 1284 (33.7) 73 (33.8) Middle 1270 (46.4) 1324 (48.1) 1814 (47.6) 104 (48.2) High 427 (15.6) 483 (17.5) 714 (18.7) 39 (18.1).0037 Behavioral Factor Drinker, n (%) None 1331 (47.7) 1500 (53.6) 2079 (53.6) 134 (59.3) Moderate 1120 (40.1) 1027 (36.7) 1399 (36.1) 72 (31.9) Heavy 339 (12.2) 271 (9.7) 403 (10.4) 20 (8.9) Smoker, n (%) None 1484 (53.2) 1607 (57.4) 2399 (61.8) 141 (62.4) Physical Activity, n (%) Light 358 (12.8) 312 (11.2) 449 (11.6) 17 (7.5) Moderate 775 (27.8) 745 (26.6) 856 (22.1) 47 (21.0) Heavy 173 (6.2) 134 (4.8) 177 (4.6) 21 (9.3) None 43 (1.6) 48 (1.8) 72 (1.9) 8 (3.7) Low 712 (26.7) 1008 (37.4) 1248 (33.4) 87 (40.1) Moderate 1184 (44.3) 1134 (42.1) 1564 (42.6) 82 (37.8) High 731 (27.4) 507 (18.8) 828 (22.1) 40 (18.4) <.0001 <.0001 <.0001

34 Table 1. General Characteristics of the Study Participants at Baseline by Exposure Status Characteristics Risk Factors for Cardiovascular Disease Normal Sarcopenia Obesity Sarcopenic Obesity N=2790 N=2798 N=3869 N=238 (28.8%) (28.9%) (40.0%) (2.3%) P-value Hypertension, n (%) 290 (10.4) 253 (9.0) 821 (21.2) 42 (18.6) <.0001 Diabetes, n (%) 164 (5.9) 159 (5.7) 294 (7.6) 15 (6.6).0196 Kidney Disease, n (%) 75 (2.7) 69 (2.5) 110 (2.8) 7 (3.1).8043 Family History Hypertension, n (%) 454 (16.3) 476 (17.0) 848 (21.9) 33 (14.6) <.0001 Diabetes, n (%) 309 (11.1) 294 (10.5) 486 (12.5) 26 (11.5).066 Heart Disease, n (%) 126 (4.5) 125 (4.5) 179 (4.6) 8 (3.5).897 CRP (mg/dl), mean±sd Total Cholesterol (mg/dl), mean±sd HDL (mg/dl), mean±sd LDL (mg/dl), mean±sd Triglyceride (mg/dl), mean±sd 0.23 ± ± ± ± ± ± ± ± ± ± ± 36.5 < ± ± ± 10.3 < ± ± ± ± ± 35.6 < ± Physical Variable BMI, mean±sd 23.1 ± ± ± ± FFMI, mean±sd 18.2 ± ± ± ± 1.1 <.0001 SD = Standard Deviation; CRP = C-Reactive Protein; HDL = High-density Lipoprotein; LDL = Low-density Lipoprotein; BMI = Body Mass Index; FFMI = Fat-free Mass Index

35 Prevalence of Sarcopenia, Obesity, and Sardopenic Obesity (per 1000 person-year) Follow-up year Attrition Rate (%) Normal Sarcopenia Obesity Sarcopenic Obesity Attrition (%)

37 25.00 Prevalence of CVD (per person-year) Follow-up year Overall CVD (n=229) MI (n=40) CeVD (n=94) CHF (n=5) CAD (n=98)

43 Table 4. Risks of Cardiovascular Diseases Related to Exposure by Each Model Model 1 Model 2 Model 3 Cardiovascular Disease (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.71 ( )* 0.68 ( )* 0.72 ( )* Obese 1.57 ( )* 1.61 ( )* 1.46 ( )* Sarcopenic-Obese 1.06 ( ) 1.12 ( ) 1.04 ( ) Congestive Heart Disease (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.53 ( ) 0.46 ( ) 0.45 ( ) Obese 5.67 ( ) 6.40 ( ) 6.75 ( ) Sarcopenic-Obese Myocardial Infarction (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.73 ( ) 0.65 ( ) 0.70 ( ) Obese 2.21 ( )* 2.60 ( )* 2.42 ( )* Sarcopenic-Obese 4.11 ( )* 4.08 ( )* 3.86 ( )* Coronary Artery Disease (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.64 ( ) 0.60 ( )* 0.67 ( ) Obese 1.34 ( ) 1.43 ( ) 1.21 ( ) Sarcopenic-Obese 0.48 ( ) 0.52 ( ) 0.46 ( ) Cerebrovascular Disease (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.87 ( ) 0.89 ( ) 0.93 ( ) Obese 1.41 ( ) 1.35 ( ) 1.25 ( ) Sarcopenic-Obese 0.48 ( ) 0.50 ( ) 0.43 ( ) Results are reported as hazard ratio (95% confidence interval). *p<0.05 vs referent group. Model 1 : adjusted for age, sex, education level, marital status, and income. Model 2 : same as Model 1 + behavioral factors including alcohol, smoking, and physical activity. Model 3 : same as Model 2 + cardiovascular risk factors including hypertension, diabetes, kidney disease, CRP, total cholesterol, HDL, LDL, triglycerides and family history.

53 Table 8. Association of Sarcopenia, Obesity, and Sarcopenic Obesity with CVD in the Middle-aged Group (40-59) Model 1 Model 2 Model 3 Overall Cardiovascular Disease (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.84 ( ) 0.78 ( ) 0.83 ( ) Obese 1.30 ( ) 1.31 ( ) 1.16 ( ) Sarcopenic obese 0.93 ( ) 0.92 ( ) 0.87 ( ) Congestive Heart Failure (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.85 ( ) 1.03 ( ) 1.23 ( ) Obese 4.02 ( ) 3.91 ( ) 3.04 ( ) Sarcopenic obese Myocardial Infarction (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.40 ( ) 0.30 ( )* 0.30 ( ) Obese 2.04 ( ) 2.55 ( )* 2.47 ( )* Sarcopenic obese 2.73 ( ) 2.73 ( ) 2.63 ( ) Coronary Artery Disease (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.86 ( ) 0.84 ( ) 0.93 ( ) Obese 1.00 ( ) 0.97 ( ) 0.80 ( ) Sarcopenic obese 1.20 ( ) 1.19 ( ) 1.15 ( ) Cerebrovascular Disease (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 1.13 ( ) 1.07 ( ) 1.11 ( ) Obese 1.16 ( ) 1.19 ( ) 1.12 ( ) Sarcopenic obese CVD: Cardiovascular disease Results are reported as hazard ratio (95% confidence interval). *p<0.05 vs referent group. Model 1 : adjusted for age, sex, education level, marital status, and income. Model 2 : same as Model 1 + behavioral factors including alcohol, smoking, and physical activity. Model 3 : same as Model 2 + cardiovascular risk factors including hypertension, diabetes, kidney disease, CRP, total cholesterol, HDL, LDL, triglycerides and family history.

55 Table 9. Association of Sarcopenia, Obesity, and Sarcopenic Obesity with CVD in the Older Group (60-69) Model 1 Model 2 Model 3 Overall Cardiovascular Disease (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.58 ( )* 0.51 ( )* 0.56 ( )* Obese 2.15 ( )* 2.31 ( )* 2.22 ( )* Sarcopenic obese 1.22 ( ) 1.43 ( ) 1.21 ( ) Congestive Heart Failure (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic Obese Sarcopenic obese Myocardial Infarction (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 2.12 ( ) 2.04 ( ) 2.46 ( ) Obese 2.09 ( ) 2.10 ( ) 1.91 ( ) Sarcopenic obese 5.99 ( )* 5.44 ( )* 5.61 ( )* Coronary Artery Disease (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.44 ( )* 0.36 ( )* 0.38 ( )* Obese 2.04 ( )* 2.64 ( )* 2.49 ( )* Sarcopenic obese Cerebrovascular Disease (HR) Normal 1.00 (REF) 1.00 (REF) 1.00 (REF) Sarcopenic 0.57 ( ) 0.63 ( ) 0.64 ( ) Obese 2.00 ( ) 1.77 ( ) 1.72 ( ) Sarcopenic obese 0.95 ( ) 1.10 ( ) 0.86 ( ) CVD: Cardiovascular disease Results are reported as hazard ratio (95% confidence interval). *p<0.05 vs referent group. Model 1 : adjusted for age, sex, education level, marital status, and income. Model 2 : same as Model 1 + behavioral factors including alcohol, smoking, and physical activity. Model 3 : same as Model 2 + cardiovascular risk factors including hypertension, diabetes, kidney disease, CRP, total cholesterol, HDL, LDL, triglycerides and family history.

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저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할

저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할수없습니다. 변경금지. 귀하는이저작물을개작, 변형또는가공할수없습니다. 귀하는, 이저작물의재이용이나배포의경우,