背景:心血管疾病(CVDs)对公众健康构成重大威胁。证据表明,中心性肥胖和正常体重指数(BMI)的组合与心血管疾病和死亡率的风险增加有关。然而,我国中老年人的证据有限。
方法:这是一项前瞻性队列研究,使用了6,494名45岁及以上成年人的全国代表性样本。这些人参加了2011年至2018年的中国健康与退休纵向研究。高度,测量体重和腰围(WC),BMI按身高和体重计算。其他变量通过自我报告问卷获得。使用Cox比例风险回归模型进行关联分析。
结果:共调查了10,186名参与者,57,185人年的随访。在此期间,发生1,571次CVD,包括1173种心脏病和527种中风.在调整了包括年龄在内的各种因素后,性别,教育,婚姻状况,吸烟状况,酒精摄入量,社会活动,高血压,血脂异常,糖尿病,癌症,慢性肺病,肝病,肾病,消化系统疾病,ENP(情感,紧张,或精神病问题),记忆相关疾病,关节炎或风湿病,哮喘,自我评估的健康和抑郁,结果显示,与WC正常体重指数(BMI)的人相比,中心性肥胖BMI正常的个体患CVD的风险高27.9%(95%置信区间[CI]:1.074-1.524),心脏病发病率增加33.4%(95%CI:1.095-1.625),而与卒中无显著关联。此外,体重指数正常WC高的患者患CVD的风险高24.6%(95%CI:1.046-1.483),心脏病发病率增加29.1%(95%CI:1.045-1.594),再次与卒中无显著关联。最后,高BMI中心性肥胖患者心血管疾病发生率高49.3%(95%CI:1.273-1.751),心脏病发病率增加61%(95%CI:1.342-1.931),卒中发生率增加34.2%(95%CI:1.008-1.786)。年龄和性别特异性分析进一步揭示了这些关联的不同趋势。
结论:我们发现体重指数(BMI)和中心性肥胖与CVD发病率的联合相关性显示出显著增强的预测价值。具体来说,中心性肥胖患者的高BMI与CVD发病风险增加显著相关.此外,中心性肥胖与正常的BMI或正常的WC再加上高BMI显着增加心脏病发病率的风险,但不是中风。值得注意的是,男性和中年人表现出更高的心脏病发病率倾向.我们的研究强调了维持最佳BMI和预防腹部肥胖在促进心血管健康中的重要性。
BACKGROUND: Cardiovascular diseases (CVDs) pose a significant threat to public health. Evidence indicates that the combination of central obesity and normal body mass index (BMI) is associated with an increased risk of cardiovascular disease and mortality. However, limited evidences exists in middle aged and elderly adults in China.
METHODS: This was a prospective cohort study that utilized a nationally representative sample of 6,494 adults aged 45 years and above. These individuals participated in the China Health and Retirement Longitudinal Study spanning from 2011 to 2018. Height, weight and waist circumference (WC) were measured, and BMI was calculated by height and weight. Other variables were obtained through self-reported questionnaires. Association analysis was conducted using Cox proportional hazard regression models.
RESULTS: A total of 10,186 participants were investigated, with 57,185 person-years of follow-up. During this period, 1,571 CVDs occurred, including 1,173 heart diseases and 527 strokes. After adjusting for various factors including age, gender, education, marital status, smoking status, alcohol intake, social activity, hypertension, dyslipidemia, diabetes, cancer, chronic lung diseases, liver disease, kidney disease, digestive disease, ENP(emotional, nervous, or psychiatric problems), memory related disease, arthritis or rheumatism, asthma, self-rated health and depression, the results revealed that compared to those with normal WC normal body mass index (BMI), individuals with central obesity normal BMI had a 27.9% higher risk of CVD incidence (95% confidence interval [CI]:1.074-1.524), and a 33.4% higher risk of heart disease incidence (95% CI:1.095-1.625), while no significant association was found with stroke. Additionally, those with normal WC high BMI showed a 24.6% higher risk of CVD incidence (95% CI:1.046-1.483), and a 29.1% higher risk of heart disease incidence (95% CI:1.045-1.594), again with no significant association with stroke. Finally, individuals with central obesity high BMI exhibited a 49.3% higher risk of CVD incidence (95% CI:1.273-1.751), a 61% higher risk of heart disease incidence (95% CI:1.342-1.931), and a 34.2% higher risk of stroke incidence (95% CI:1.008-1.786). Age- and sex- specific analyses further revealed varying trends in these associations.
CONCLUSIONS: We discovered that the combined association of body mass index(BMI) and central obesity with CVD incidence exhibited a significantly enhanced predictive value. Specifically, a high BMI with central obesity was notably linked to an increased risk of CVD incidence. Additionally, central obesity with a normal BMI or a normal WC coupled with a high BMI significantly augmented the risk of heart disease incidence, but not stroke. Notably, male and middle-aged adults demonstrated a greater propensity for heart disease incidence. Our study underscores the importance of maintaining an optimal BMI and preventing abdominal obesity in promoting cardiovascular health.