中老年人群超重肥胖联合代谢综合征与心血管疾病发病风险的关联研究

Correlation between overweight/obesity with metabolic syndrome and the risk of developing cardiovascular diseases among middle-aged and elderly adults

目的探究中老年人群超重肥胖和代谢综合征的联合作用与心血管疾病发病风险的关系,为预防心血管疾病的发生提供科学依据。方法该研究资料来源于中国健康与养老追踪调查(CHARLS)2011年基线数据以及2013年、2015年和2018年3次随访数据。采用多阶段分层概率抽样方法抽取全国28个省(自治区,直辖市)的4926名45岁及以上中老年居民为研究对象,进行问卷调查、体格检查和实验室检测。采用Stata 15.1统计软件进行χ2检验和多因素Cox回归分析。结果平均随访6.52年后,新发心血管疾病705例,发病率为14.31%。其中,心脏病529例,发病率为10.74%;脑卒中232例,发病率为4.71%。多因素Cox回归分析结果显示,调整混杂因素后,超重肥胖(HR=1.38,95%CI:1.17~1.64)和代谢综合征(HR=1.33,95%CI:1.12~1.59)均会增加中老年人心血管疾病发病风险(P<0.01)。在联合作用分析中,与代谢正常非超重肥胖组相比,代谢正常超重肥胖(HR=1.42,95%CI:1.16~1.74)、代谢异常非超重肥胖(HR=1.41,95%CI:1.06~1.88)和代谢异常超重肥胖(HR=1.83,95%CI:1.51~2.23)均与心血管疾病高风险相关(P<0.05,P<0.01)。结论超重肥胖和代谢综合征的联合作用与中老年人群心血管疾病发生风险显著增加有关。需要引导中老年人进行超重肥胖与代谢综合征的防控,降低心血管疾病的患病率,减轻疾病负担。

Objective To explore the combined effects of overweight/obesity and metabolic syndrome on the risk of cardiovascular diseases,and provide the scientific basis for the prevention of cardiovascular diseases.Methods The data were from the China Health and Retirement Longitudinal Survey(CHARLS)in 2011 baseline data and in 2013,2015 and 2018 follow-up data.The multi-stage stratified probability sampling method was used to select 4926 middle-aged and elderly adults(≥45 years old)from 28 provinces(autonomous regions and municipalities)as the subjects.The investigation was performed with the questionnaire,physical examination,and laboratory test.Theχ2 test and multivariate Cox regression were used to analyze the data.The used software was Stata 15.1.Results After a mean follow-up period of 6.52 years,705 subjects with cardiovascular diseases occurred(14.31%).Among them,529 had heart disease(10.74%);232 had stroke(4.71%).The multivariate Cox regression showed that after adjusting the confounding factors,overweight/obese(HR=1.38,95%CI:1.17-1.64)and metabolic syndrome(HR=1.33,95%CI:1.12-1.59)could increase the risk of cardiovascular diseases in the middle-aged and elderly adults(P<0.01).In combined effects analysis,as compared with normal metabolic non-overweight/obese group,normal metabolic overweight/obese group(HR=1.42,95%CI:1.16-1.74),abnormal metabolic non-overweight/obese group(HR=1.41,95%CI:1.06-1.88),and abnormal metabolic overweight/obese group(HR=1.83,95%CI:1.51-2.23)positively correlated with higher risk of cardiovascular diseases(P<0.05,P<0.01).Conclusion The combined effects of overweight/obesity and metabolic syndrome significantly increases the risk of developing cardiovascular disease in middle-aged and elderly adults.It is necessary to guide the middle-aged and elderly adults to prevent and control the overweight/obesity and metabolic syndrome,decreasing the morbidity of cardiovascular diseases,and reducing the disease burden.