INS and obesity due to melanocortin 4 receptor deficiency: In the adjusted analysis, anticoagulant use (OR = 5.31; 95%CI: 4.91, 5.74), black race/ethnicity (OR = 2.05; 95%CI: 1.94, 2.16), insulin use (OR = 2.53; 95%CI: 2.37, 2.71), contraceptive/hormone use (OR = 1.85; 95%CI: 1.46, 2.35), obesity (OR = 1.84; 95%CI: 1.76, 1.93), MS(OR = 1.80; 95%CI: 1.66, 1.96), smoking use (OR = 1.65; 95%CI: 1.42, 1.91), anemia (OR = 1.30; 95%CI: 1.22, 1.37), and alcohol use (OR = 1.11; 95%CI: 1.00, 1.23) were associated with increased odds of MACE events in addition to HMB (OR = 1.30; 95%CI: 1.10, 1.54) (Additional file 1: Table S9).