Relationship between BMI, abdominal obesity and the incidence of acute myocardial infarction in Chinese adults: a prospective study
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摘要:
目的 了解中国成人BMI和腹型肥胖与急性心肌梗死(acute myocardial infarction, AMI)的发病关系。 方法 从2010年中国慢性病及危险因素监测中抽取11个省(市),再从中选择60个监测点作为随访点,并于2016―2017年进行随访调查,共随访到27 604人,数据清理后共26 794名调查对象纳入分析。采用Cox比例风险回归模型分析BMI和腹型肥胖与AMI发病的关系。 结果 26 794名调查对象,平均随访6.0年,随访期间共观察到256例AMI事件。在调整相关混杂因素后,与腰围(waist circumference, WC)正常、BMI < 24 kg/m2组相比,腹型肥胖、BMI < 24 kg/m2组AMI的发病风险增加85%(HR=1.85, 95% CI: 1.14~3.01),腹型肥胖、BMI≥24 kg/m2组AMI的发病风险增加56%(HR=1.56, 95% CI: 1.11~2.18),而WC正常、BMI≥24 kg/m2组与AMI的发病风险无相关(HR=0.85, 95% CI: 0.49~1.47)。 结论 无论BMI值为多少,腹型肥胖都是AMI发病的重要危险因素。 Abstract:Objective To investigate the relationship between BMI, abdominal obesity and the incidence of acute myocardial infarction (AMI) in Chinese adults. Methods Eleven Provinces/Cities were selected from 2010 China Chronic Disease Risk Factor Surveillance, and 60 surveillance sites were selected as follow-up spots. A total of 27 604 participants were followed up from 2016 to 2017. Finally, a total of 26 794 subjects were included in the analysis. The Cox proportional hazard regression model was used to analyze the relationship between BMI, abdominal obesity and the incidence of AMI. Results A total of 26 794 subjects were follow-up for an average of 6.0 years. During the follow-up period, of 256 cases of AMI were observed. After adjusting for relevant confounders, compared with normal waist circumference (WC) and BMI < 24 kg/m2 group, the risk of AMI in abdominal obesity and BMI < 24 kg/m2 group increased by 85% (HR=1.85, 95% CI: 1.14-3.01), and the risk of AMI in abdominal obesity group and BMI≥24 kg/m2 group increased by 56% (HR=1.56, 95% CI: 1.11-2.18). However, there was no significant correlation between the risk of AMI and the subjects with normal WC and BMI≥24 kg/m2 (HR=0.85, 95% CI: 0.49-1.47). Conclusion Abdominal obesity is an important risk factor for AMI regardless of BMI. -
Key words:
- BMI /
- Abdominal obesity /
- Acute myocardial infarction /
- Prospective study
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表 1 2010年中国11省市研究对象基线特征[n(%)]
Table 1. Baseline characteristics of subjects in 11 Provinces and Cities of China in 2010 [n(%)]
变量 WC正常BMI < 24 kg/m2(n=12 350) WC正常BMI≥24 kg/m2(n=3 085) 腹型肥胖BMI < 24 kg/m2(n=1 931) 腹型肥胖BMI≥24 kg/m2(n=9 428) P值 年龄(x±s, 岁) 46.07±14.52 46.62±12.35 51.14±13.69 49.53±12.59 < 0.001 年龄组(岁) < 0.001 18~ < 45 5 867 (47.51) 1 408 (45.64) 627 (32.47) 3 336 (35.38) 45~ < 60 4 097 (33.17) 1 184 (38.38) 783 (40.55) 4 040 (42.85) ≥60 2 386 (19.32) 493 (15.98) 521 (26.98) 2 052 (21.76) 男 5 919 (47.93) 1 473 (47.75) 700 (36.25) 3 927 (41.66) < 0.001 文化程度 < 0.001 小学以下 5 657 (45.81) 1 285 (41.65) 1 001 (51.84) 4 330 (45.93) 小学 4 118 (33.34) 1 121 (36.34) 583 (30.19) 3 090 (32.77) 初中 1 679 (13.59) 469 (15.20) 257 (13.31) 1 394 (14.79) 高中及以上 896 (7.26) 210 (6.81) 90 (4.66) 614 (6.51) 婚姻状况a < 0.001 未婚 1 054 (8.55) 143 (4.65) 59 (3.06) 256 (2.72) 已婚/同居 10 056 (81.61) 2 668 (86.79) 1 640 (85.06) 8 210 (87.28) 丧偶/离婚/分居 1 213 (9.84) 263 (8.56) 229 (11.88) 941 (10.00) 家庭年总收入(元) 0.054 < 10 000 4 135 (33.48) 975 (31.60) 631 (32.68) 2 970 (31.50) 10 000~ < 20 000 2 784 (22.54) 746 (24.18) 447 (23.15) 2 142 (22.72) 20 000~ < 30 000 1 926 (15.60) 509 (16.50) 296 (15.32) 1 577 (16.73) ≥30 000 3 505 (28.38) 855 (27.72) 557 (28.85) 2 739 (29.05) 城市 4 446 (36.00) 1 188 (38.51) 738 (38.22) 4 133 (43.84) < 0.001 吸烟状况 < 0.001 当前吸烟 3 529 (28.58) 716 (23.21) 407 (21.05) 1 996 (21.17) 以前吸烟 326 (2.64) 115 (3.73) 39 (2.05) 255 (2.70) 从不吸烟 8 493 (68.78) 2 254 (73.06) 1 485 (76.90) 7 177 (76.13) 当前饮酒 4 665 (37.78) 1 147 (37.18) 659 (34.13) 3 279 (34.78) < 0.001 糖尿病 429 (3.47) 148 (4.80) 145 (7.51) 1 065 (11.30) < 0.001 血脂异常 4 913 (39.78) 1 695 (54.94) 980 (50.75) 6 284 (66.65) < 0.001 蔬果摄入不足 6 723 (54.44) 1 631 (52.87) 1 127 (58.36) 5 341 (56.65) < 0.001 身体活动不足 2 088 (16.91) 558 (18.09) 391 (20.25) 1 806 (19.16) < 0.001 红肉摄入过多 1 629 (13.19) 404 (13.10) 179 (9.27) 1 163 (12.34) < 0.001 高血压 3 398 (27.51) 1 288 (41.75) 789 (40.86) 5 321 (56.44) < 0.001 SBP (x±s, mmHg) 128.39±20.12 135.09±20.88 135.82±21.51 141.31±22.19 0.012 DBP (x±s, mmHg) 77.86±10.63 82.81±11.18 81.65±10.58 86.34±11.49 < 0.001 TG (x±s, mmol/L) 1.16±1.03 1.49±1.43 1.46±1.28 1.85±1.63 < 0.001 TC (x±s, mmol/L) 3.92±1.00 4.12±1.15 4.18±1.05 4.30±1.13 < 0.001 HDL-C (x±s, mmol/L) 1.19±0.33 1.09±0.29 1.12±0.30 1.04±0.28 < 0.001 LDL-C (x±s, mmol/L) 2.14±0.72 2.35±0.81 2.36±0.77 2.50±0.79 < 0.001 FPG (x±s, mmol/L) 5.32±1.16 5.48±1.18 5.68±1.69 5.79±1.56 < 0.001 OGTT-2h (x±s, mmol/L) 6.01±21.18 6.27±2.51 6.62±2.97 6.89±2.84 0.519 注:a缺失62例;口服糖耐量试验(oral glucose tolerance test, OGTT)。 表 2 2010年中国11省市随访人群与失访人群特征分析[n(%)]
Table 2. Analysis of the characteristics of follow-up population and lost follow-up population in 11 Provinces and Cities of China in 2010 [n(%)]
变量 随访人群 失访人群 χ2/t值 P值 人数 27 604 (75.78) 8 822 (24.22) 年龄(x±s, 岁) 48.22 ±14.15 44.12 ±17.07 22.50 < 0.001 男 12 485 (45.23) 4 165 (47.21) 10.59 0.001 城市 10 772 (39.02) 4 395 (49.82) 320.61 < 0.001 吸烟 6 894 (24.98) 1 987 (22.53) 24.70 < 0.001 饮酒 10 018 (36.30) 3 315 (37.58) 4.73 0.030 超重肥胖 14 796 (53.60) 5 043 (57.16) 34.22 < 0.001 腹型肥胖 11 677 (42.30) 3 505 (39.73) 18.19 < 0.001 糖尿病 2 856 (10.35) 943 (10.69) 0.84 0.359 血脂异常 14 298 (51.80) 4 690 (53.16) 5.00 0.025 蔬果摄入不足 15 331 (55.54) 5 011 (56.80) 4.32 0.038 身体活动不足 5 073 (18.38) 1 903 (21.57) 44.03 < 0.001 红肉摄入过多 3 449 (12.49) 1 133 (12.84) 0.74 0.390 高血压 11 277 (40.67) 3 104 (35.18) 84.34 < 0.001 SBP (x±s, mmHg) 134.50 ±21.97 132.00 ±22.10 9.07 < 0.001 DBP (x±s, mmHg) 81.73 ±11.68 80.47 ±11.76 8.72 < 0.001 TG (x±s, mmol/L) 1.46 ±1.36 1.41 ±1.40 3.03 0.002 TC (x±s, mmol/L) 4.10 ±1.08 4.03 ±1.10 4.88 < 0.001 HDL-C (x±s, mmol/L) 1.12 ±0.31 1.11 ±0.31 3.27 0.001 LDL-C (x±s, mmol/L) 2.30 ±0.78 2.28 ±0.80 1.84 0.065 FPG (x±s, mmol/L) 5.54 ±1.39 5.53 ±1.51 0.20 0.843 OGTT-2h (x±s, mmol/L) 6.40 ±14.48 6.34 ±2.68 0.40 0.692 表 3 不同BMI和腹型肥胖分组与AMI发病的关系
Table 3. Relationship between different BMI and abdominal obesity groups and the incidence of acute myocardial infarction
变量 WC正常BMI < 24 kg/m2(n=12 350) WC正常BMI≥24 kg/m2(n=3 085) 腹型肥胖BMI < 24 kg/m2(n=1 931) 腹型肥胖BMI≥24 kg/m2(n=9 428) AMI 发病人数 75 26 25 130 随访人年 73 992.35 18 448.90 11 552.43 56 366.27 发病密度(/10万人年) 101.36 140.93 216.41 230.63 HR(95% CI)值 模型1 1.00 0.96(0.56~1.64) 2.04(1.26~3.30) 2.01(1.47~2.74) 模型2 1.00 0.85(0.50~1.46) 1.82(1.12~2.95) 1.52(1.10~2.12) 模型3 1.00 0.85(0.49~1.47) 1.85(1.14~3.01) 1.56(1.11~2.18) 注:模型1:调整年龄、性别;模型2:在模型1基础上调整高血压、血脂异常、糖尿病;模型3:在模型2基础上调整文化程度、收入、婚姻状况、吸烟、饮酒、身体活动不足、蔬果摄入不足、红肉摄入过多。 -
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