作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Prospective Association Between Chinese Visceral Adiposity Index and Risk of Stroke Incidence in Middle-aged and Elderly Chinese Population
-
摘要: 目的 利用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study， CHARLS）数据，分析中国人内脏脂肪指数（Chinese Visceral Adiposity Index， CVAI）与中老年人群（≥45岁）脑卒中发病风险的关系。方法 对2015年、2018年和2020年CHARLS数据库中的中老年人数据进行分析，以随访期内新发脑卒中事件（包括出血性脑卒中和缺血性脑卒中）为结局指标，同时以一般人口学特征、生活方式、健康状况和血液生物标志物作为协变量，采用Cox比例风险回归模型探索CVAI与脑卒中发病风险的剂量-反应关系。结果 共11 432名中老年人纳入本研究，平均年龄为（60.24 ±9.56）岁。其中女性6157人（53.86%），男性5275人（46.14%）。在5年中位随访期内，共有905名中老年人发生脑卒中，在调整一般人口学和生活方式等协变量后，CVAI每增加一个四分位数间距（interquartile range， IQR），脑卒中发病风险增加28%（HR=1.28，95%CI: 1.20 ～ 1.36）。与第一个四分位数（Q1）组相比，Q3（HR=1.60， 95%CI: 1.30 ～ 1.97）和Q4（HR=2.02， 95%CI: 1.65 ～ 2.47）组中老年人与脑卒中发病风险增加有关，交互作用分析显示，CVAI与性别具有交互作用(P for interaction＜0.001)。限制性立方样条图显示，CVAI与脑卒中发病风险呈非线性关联(P nonlinear=0.005)。结论 较高水平的CVAI与脑卒中发病风险增加有关，CVAI是一种有效的生物标志物，可用于识别脑卒中的高风险个体，为脑卒中的一级预防提供参考。Abstract: Objective This study aims to analyze the association between the Chinese Visceral Adiposity Index (CVAI) and the risk of stroke onset in middle-aged and older adults (≥45 years) using data from the China Health and Retirement Longitudinal Study (CHARLS). Methods Data from the 2015, 2018, and 2020 CHARLS surveys were used to analyze middle-aged and elderly participants. The outcome was new stroke events (including both hemorrhagic and ischemic strokes) during the follow-up period. General demographic characteristics, lifestyle factors, health status, and blood biomarkers were considered as covariates. The Cox proportional hazards regression model was employed to explore the dose-response relationship between CVAI and the risk of stroke onset. Results A total of 11 432 middle-aged and elderly individuals were included, with an average age of （60.24 ±9.56）years. Among them, 6157 (53.86%) were women and 5275 (46.14%) were men. Over a median follow-up period of 5 years, 905 individuals developed stroke. After adjusting for general demographic characteristics and lifestyle covariates, for each interquartile range (IQR) increase in CVAI, the risk of stroke onset increased by 28% (HR= 1.28, 95% CI: 1.20–1.36). Compared to the first quartile (Q1), the third quartile (Q3) (HR= 1.60, 95% CI: 1.30–1.97) and fourth quartile (Q4) (HR= 2.02, 95% CI: 1.65–2.47) were significantly associated with an increased risk of stroke. Interaction analysis showed a significant interaction between CVAI and gender (Pfor interaction< 0.001). The restricted cubic spline analysis revealed a non-linear relationship between CVAI and stroke risk (Pnonlinear= 0.005). Conclusions Higher levels of CVAI are associated with an increased risk of stroke. CVAI is an effective biomarker for identifying individuals at high risk for stroke and can be used for primary stroke prevention strategies.
-
-
[1] SAINI V, GUADA L, YAVAGAL D R. Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions [J]. Neurology, 2021, 97(20 Suppl 2): S6-s16, https://doi.org/ 10.1212/wnl.0000000000012781
[2] Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021, 20(10): 795-820, https://doi.org/ 10.1016/s1474-4422(21)00252-0
[3] MA Q, LI R, WANG L, et al. Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the Global Burden of Disease Study 2019[J]. Lancet Public Health, 2021, 6(12): e897-e906, https://doi.org/ 10.1016/s2468-2667(21)00228-0
[4] 江湖, 王晓萱, 张振香, et al. 脑卒中患者医院-家庭过渡期体验质性研究的Meta整合[J]. 中国全科医学: 1-8. [5] YAO M, REN Y, JIA Y, et al. Projected burden of stroke in China through 2050[J]. Chin Med J (Engl), 2023, 136(13): 1598-605, https://doi.org/ 10.1097/cm9.0000000000002060
[6] WHO. Obesity and overweight [Z]. June 9, 2021
[7] Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants [J]. Lancet, 2016, 387(10026): 1377-96, https://doi.org/ 10.1016/s0140-6736(16)30054-x
[8] PILLAY P, LEWINGTON S, TAYLOR H, et al. Adiposity, Body Fat Distribution, and Risk of Major Stroke Types Among Adults in the United Kingdom [J]. JAMA Netw Open, 2022, 5(12): e2246613, https://doi.org/ 10.1001/jamanetworkopen.2022.46613
[9] XIA M F, LIN H D, CHEN L Y, et al. Association of visceral adiposity and its longitudinal increase with the risk of diabetes in Chinese adults: A prospective cohort study [J]. Diabetes Metab Res Rev, 2018, 34(7): e3048, https://doi.org/ 10.1002/dmrr.3048
[10] ZHANG H, ZHAN Q, DONG F, et al. Associations of Chinese visceral adiposity index and new-onset stroke in middle-aged and older Chinese adults: an observational study [J]. Lipids Health Dis, 2023, 22(1): 74, https://doi.org/ 10.1186/s12944-023-01843-x
[11] XIA M F, CHEN Y, LIN H D, et al. A indicator of visceral adipose dysfunction to evaluate metabolic health in adult Chinese [J]. Sci Rep, 2016, 6: 38214, https://doi.org/ 10.1038/srep38214
[12] BLüHER M. Obesity: global epidemiology and pathogenesis [J]. Nat Rev Endocrinol, 2019, 15(5): 288-98, https://doi.org/ 10.1038/s41574-019-0176-8
[13] FU S, LUO L, YE P, et al. Overall and abdominal obesity indicators had different association with central arterial stiffness and hemodynamics independent of age, sex, blood pressure, glucose, and lipids in Chinese community-dwelling adults [J]. Clinical interventions in aging, 2013, 8: 1579-84, https://doi.org/ 10.2147/cia.S54352
[14] ZHAO Y, ZHANG J, CHEN C, et al. Comparison of six surrogate insulin resistance indexes for predicting the risk of incident stroke: The Rural Chinese Cohort Study [J]. Diabetes Metab Res Rev, 2022, 38(7): e3567, https://doi.org/ 10.1002/dmrr.3567
[15] LIU Z, HUANG Q, DENG B, et al. Elevated Chinese visceral adiposity index increases the risk of stroke in Chinese patients with metabolic syndrome [J]. Front Endocrinol (Lausanne), 2023, 14: 1218905, https://doi.org/ 10.3389/fendo.2023.1218905
[16] ZHAO Y, HU Y, SMITH J P, et al. Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS) [J]. Int J Epidemiol, 2014, 43(1): 61-8, https://doi.org/ 10.1093/ije/dys203
[17] GONG J, WANG G, WANG Y, et al. Nowcasting and forecasting the care needs of the older population in China: analysis of data from the China Health and Retirement Longitudinal Study (CHARLS) [J]. Lancet Public Health, 2022, 7(12): e1005-e13, https://doi.org/ 10.1016/s2468-2667(22)00203-1
[18] XIE D, WANG J. Comparison of self-reports and biomedical measurements on hypertension and diabetes among older adults in China [J]. BMC Public Health, 2020, 20(1): 1664, https://doi.org/ 10.1186/s12889-020-09770-7
[19] XU R, HU X, WANG T, et al. Visceral Adiposity and Risk of Stroke: A Mendelian Randomization Study [J]. Front Neurol, 2022, 13: 804851, https://doi.org/ 10.3389/fneur.2022.804851
[20] YANO Y, VONGPATANASIN W, AYERS C, et al. Regional Fat Distribution and Blood Pressure Level and Variability: The Dallas Heart Study [J]. Hypertension, 2016, 68(3): 576-83, https://doi.org/ 10.1161/hypertensionaha.116.07876
[21] FOX C S, MASSARO J M, HOFFMANN U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study [J]. Circulation, 2007, 116(1): 39-48, https://doi.org/ 10.1161/circulationaha.106.675355
[22] WANG Z, ZENG X, CHEN Z, et al. Association of visceral and total body fat with hypertension and prehypertension in a middle-aged Chinese population [J]. J Hypertens, 2015, 33(8): 1555-62, https://doi.org/ 10.1097/hjh.0000000000000602
[23] BI H, ZHANG Y, QIN P, et al. Association of Chinese Visceral Adiposity Index and Its Dynamic Change With Risk of Carotid Plaque in a Large Cohort in China [J]. J Am Heart Assoc, 2022, 11(1): e022633, https://doi.org/ 10.1161/jaha.121.022633
[24] EMDIN C A, KHERA A V, NATARAJAN P, et al. Genetic Association of Waist-to-Hip Ratio With Cardiometabolic Traits, Type 2 Diabetes, and Coronary Heart Disease [J]. Jama, 2017, 317(6): 626-34, https://doi.org/ 10.1001/jama.2016.21042
[25] LAU D C, DHILLON B, YAN H, et al. Adipokines: molecular links between obesity and atheroslcerosis [J]. Am J Physiol Heart Circ Physiol, 2005, 288(5): H2031-41, https://doi.org/ 10.1152/ajpheart.01058.2004
[26] VAN GAAL L F, MERTENS I L, DE BLOCK C E. Mechanisms linking obesity with cardiovascular disease [J]. Nature, 2006, 444(7121): 875-80, https://doi.org/ 10.1038/nature05487
[27] ZHANG Z, TANG J, CUI X, et al. New Insights and Novel Therapeutic Potentials for Macrophages in Myocardial Infarction [J]. Inflammation, 2021, 44(5): 1696-712, https://doi.org/ 10.1007/s10753-021-01467-2
[28] TANAKA S, TOGASHI K, RANKINEN T, et al. Sex differences in the relationships of abdominal fat to cardiovascular disease risk among normal-weight white subjects [J]. Int J Obes Relat Metab Disord, 2004, 28(2): 320-3, https://doi.org/ 10.1038/sj.ijo.0802545
[29] KANAYA A M, HARRIS T, GOODPASTER B H, et al. Adipocytokines attenuate the association between visceral adiposity and diabetes in older adults [J]. Diabetes Care, 2004, 27(6): 1375-80, https://doi.org/ 10.2337/diacare.27.6.1375
[30] NAM K W, KWON H M, JEONG H Y, et al. Visceral adiposity index is associated with silent brain infarct in a healthy population [J]. Sci Rep, 2020, 10(1): 17271, https://doi.org/ 10.1038/s41598-020-74454-6
[31] CHEN K, SHEN Z, GU W, et al. Prevalence of obesity and associated complications in China: A cross-sectional, real-world study in 15.8 million adults [J]. Diabetes Obes Metab, 2023, 25(11): 3390-9, https://doi.org/ 10.1111/dom.15238
[32] MU L, LIU J, ZHOU G, et al. Obesity Prevalence and Risks Among Chinese Adults: Findings From the China PEACE Million Persons Project, 2014-2018[J]. Circ Cardiovasc Qual Outcomes, 2021, 14(6): e007292, https://doi.org/ 10.1161/circoutcomes.120.007292
计量
- 文章访问数: 608
- HTML全文浏览量: 3
- PDF下载量: 3
下载:
