中国成年人中心性肥胖与缺血性心脏病发病风险的前瞻性研究

Association between central obesity and risk for heart disease in adults in China： a prospective study

目的分析中心性肥胖评价指标腰围与发生缺血性心脏病（IHD）、急性冠心病事件（MCE）以及死于IHD风险的关联。方法研究对象来自中国慢性病前瞻性研究，基线调查开展于2004年6月至2008年7月，剔除基线时患有冠心病、脑卒中、恶性肿瘤、慢性阻塞性肺疾病和糖尿病的个体，共纳入428595人进行分析。统计学分析采用Cox比例风险模型。结果研究人群平均随访9．1年，累积随访3803637人年，期间新发IHD26900例，MCE4320例，IHD死亡2787例。调整了多种混杂因素和BMI后，与非中心性肥胖者（男性〈85．0cm，女性〈80．0cm）相比，中心性肥胖前期者（男性85．0～89．9cm，女性80．0～84．9tin）发生1HD、MCE和死于IHD的风险HR值（95％CI）分别为1．13（1．09～1．17）、1．15（1．05～1．26）、1．11（0．98～1．24），中心性肥胖者（男性≥90．0cm，女性≥85．0cm）对应的风险效应值更高，HR值（95％C1）分别为1．29（1．24。1．34）、1．30（1．17～1．44）、1．32（1．16-1～5）。按BMl分层，即使在BMI正常的人群中，与非中心性肥胖者相比，中心性肥胖前期和中心性肥胖人群发生IHD、MCE或死于IHD的风险也会增加。结论中心性肥胖是IHD风险独立的危险因素，IHD风险随中心性肥胖测量指标腰围的增加而增加。

Objective To understand the association between central obesity, assessed by waist circumference, and the risks for ischemic heart disease （IHD）, major coronary event （MCE）, and IHD death. Methods After excluding participants with heart disease, stroke, cancer, COPD, and diabetes at baseline survey, we included a total of 428 595 participants from the China Kadoorie Biobank for the analysis. The baseline survey was conducted from June 2004 to July 2008. We used Cox proportional hazards model to estimate the hazard ratio （HR） and 95%CI. Results During an average 9.1 years of follow-up （3 803 637 person-years）, we documented 26 900 incident cases of 1HD, 4 320 cases of MCE, and 2 787 of deaths from IHD. After adjustment for possible confounders and BMI, central obesity was found to be associated with increased risks for IHD, MCE, and IHD death. The adjusted HRs （for the participants who had waist circumference of 85.0-89.9 cm in men and 80.0-84.9 cm in women were 1.13 （95%C1： 1.09-1.17） for IHD, 1.15 （95%C1： 1.05-1.26） for MCE and 1.11 （95% CI： 0.98-1.24） for IHD death. The respective HRs for those central obese participants （men ≥90.0 cm, women ≥85.0 cm） were 1.29 （95% CI： 1.24-1.34）, 1.30 （95% CI： 1.17-1.44） and 1.32 （95%CI： 1.16-1.51）. Further stratification analysis according to BMI showed that the risks for incident IHD, MCE, and IHD death increased along with the increase of waist circumference even in the participants with normal weight. Conclusion This large-scale prospective study revealed that central obesity was an independent risk factor for IHD in adults in China, and the risk of IHD would increase with the increase of waist circumference.