脂质蓄积指数和饮酒对男性高血压罹患风险的影响

Relationship of Lipid Accumulation Product and Alcohol Consumption with Risk of Hypertension in Men

背景大量饮酒和肥胖是高血压两个重要可修正的危险因素,且两种危险因素导致血压升高的机制相似。脂质蓄积指数(LAP)作为一种新的肥胖指标,与代谢性疾病的关联更为密切,其与大量饮酒对男性高血压的罹患风险可能存在交互作用。目的探讨LAP和饮酒与男性高血压罹患风险的关系,并分析高LAP和大量饮酒之间是否存在对高血压罹患风险的相加交互作用。方法于2015年7-8月采用分层随机抽样法抽取蚌埠市龙子湖区1 822例18岁以上男性常住居民为调查对象,最终1 306例调查对象纳入分析。将调查对象分为非高血压组673例和高血压组633例,并对两组的人口学特征、体格检查结果、实验室检查结果进行比较。采用约登指数确定LAP筛检高血压的最佳切点,以此为依据定义高LAP者。采用多因素Logistic回归分析高LAP和饮酒与高血压罹患风险之间的关系,并进一步评估高LAP和大量饮酒的交互作用对高血压罹患风险的影响,计算交互作用指数(SI)、超额相对危险度(RERI)和归因交互效应百分比(AP)。结果非高血压组和高血压组年龄、饮酒情况、身体活动情况、高血压家族史比较,差异有统计学意义(P<0.05);高血压组的总胆固醇、三酰甘油、空腹血糖、糖化血红蛋白、腰围、体质指数及LAP高于非高血压组,差异有统计学意义(P<0.05)。LAP筛检高血压的最佳切点为29.69 cm·mmol/L(灵敏度为0.64,特异度为0.59)。调整年龄、吸烟、身体活动及高血压家族史后,高LAP及大量饮酒的人群患高血压的风险更高,OR(95%CI)分别为2.79(2.19,3.55)、1.60(1.15,2.21)。同时存在高LAP和大量饮酒会增加高血压的罹患风险OR(95%CI)为4.75(3.10,7.27),SI(95%CI)为1.64(0.91,2.98)、RERI(95%CI)为1.47(-0.47,3.40)、AP(95%CI)为0.31(<0.01,0.62)。结论高LAP和大量饮酒会增加男性高血压的罹患风险,两者同时存在,罹患高血压的风险更大,但并未发现两者对高血压罹患风险的相加交互作用。

Background Heavy alcohol consumption and obesity are two important modifiable risk factors for hypertension,and the mechanisms of the two risk factors leading to hypertension are similar.Lipid accumulation product(LAP),a new obesity index,is more closely related to metabolic diseases.There may be interactions between high LAP and heavy alcohol consumption on the risk of hypertension in men.Objective To explore the relationship of LAP and alcohol consumption with the risk of hypertension in men,and to analyze whether there is additive interaction between high LAP and heavy alcohol consumption.Methods Stratified random sampling method was used to select 1 822 permanent male residents over 18 years in Longzihu District of Bengbu from July to August 2015,and 1 306 of them were eligible for the final analysis.Participants were divided into non-hypertension groups(n=673)and hypertension(n=633),and intergroup comparison of the demographic characteristics,results of the physical examination,laboratory examination results.The Youden’s index was used to determine the optimal cut-off point of LAP screening for hypertension.High LAP was defined as equal to or higher than the optimal cut-off point.Multivariate Logistic regression was used to analyze the relationship of high LAP and/or heavy alcohol consumption with the risk of hypertension,and to further assess the impact of interaction between high LAP and heavy alcohol consumption on hypertension.Synergy index(SI),relative excess risk due to interaction(RERI),and the attributable proportion due to interaction(AP)were calculated.Results There were significant differences in age,alcohol consumption,physical activity and family history of hypertension between hypertension and non-hypertension groups(P<0.05).The total cholesterol,triglyceride,fasting blood glucose,glycosylated hemoglobin,waist circumference,body mass index and LAP in hypertension group were significantly higher than those in non-hypertension group(P<0.05).The optimal cut-off point of LAP in the screening of hypertension was 29.69 cm·mmol/L(sensitivity and specificity were 0.64,0.59,respectively).After adjusting for age,smoking,physical activity and family history of hypertension,participants with high LAP[OR=2.79,95%CI(2.19,3.55)]or heavy alcohol consumption[OR=1.60,95%CI(1.15,2.21)]had a higher risk of hypertension.And the risk was even higher for those with both high LAP and heavy alcohol consumption[OR=4.75,95%CI(3.10,7.27),SI=1.64,95%CI(0.91,2.98),RERI=1.47,95%CI(-0.47,3.40),and AP=0.31,95%CI(<0.01,0.62)].Conclusion High LAP or heavy alcohol consumption increased the risk of hypertension in men.And the risk would be higher if both high LAP and heavy alcohol consumption coexist.But no significant additive interaction was found between the two factors on the risk of hypertension.