中青年健康体检人群肥胖与早发血管老化的相关性

Correlation between obesity and early vascular aging in middle-aged and young adult health check-up populations

目的:中国中青年肥胖率逐年升高,心血管疾病的发生呈年轻化趋势。然而,肥胖是否与早发血管老化(early vascular aging,EVA)相关目前尚未见报道。本研究旨在分析中青年健康体检人群肥胖与EVA的相关性,为心血管疾病的预防提供参考。方法:纳入2020年1至12月在中南大学湘雅三医院完成臂踝脉搏波传导速度(brachialankle pulse wave velocity,baPWV)测量的15464名18~59岁中青年健康体检者,并选择其中血压正常且无心血管风险因素的1965名受检者作为健康人群。根据健康人群各年龄段男性和女性的baPWV值,计算得到用于判断各年龄段男性和女性EVA的baPWV界值。按照年龄和性别进行分组,统计中青年健康体检人群中符合EVA标准的人数,并计算所占百分比。分别比较男性/女性EVA组和非EVA组之间肥胖指标[内脏脂肪指数(visceral adiposity index,VAI)、体重指数(body mass index,BMI)、腰围(waist circumference,WC)]的差异。以EVA作为因变量,分别将VAI、BMI、WC作为自变量纳入Logistic模型,分别分析校正其他影响因素前后各肥胖指标与EVA的相关性;并进一步分析各年龄段各肥胖指标与EVA的相关性。结果:在健康体检人群中,不同年龄组男性EVA检出率1.65%~10.92%,女性EVA检出率1.16%~10.50%;随年龄增加,男性、女性EVA检出率均呈上升趋势;且除40~<50岁年龄组,其他年龄组男性EVA检出率均高于女性。不管是男性或女性,EVA组肥胖指标VAI、BMI、WC均明显高于非EVA组(均P<0.01)。在对其他影响因素进行校正前后,VAI、WC均与EVA相关(均P<0.05)。在未校正其他影响因素时,BMI为EVA的危险因素(P<0.01),而在校正其他影响因素后,BMI与EVA的相关性不具有统计学意义(P=0.05)。校正其他影响因素后,18~<40岁、50~<60岁年龄组VAI与EVA的相关性均具有统计学意义(均P<0.05),BMI、WC与EVA的相关性均无统计学意义(均P>0.05);而在40~<50岁年龄组,VAI、BMI与EVA的相关性均无统计学意义(均P>0.05),WC与EVA的相关性有统计学意义(P<0.01)。结论:18~<40岁、50~<60岁中青年人群VAI与EVA的发生密切相关,40~<50岁中青年人群WC与EVA的发生密切相关。

Objective:The obesity rate among middle-aged and young adults in China is increasing annually,and the incidence of cardiovascular diseases is becoming more prevalent in younger populations.However,it has not yet been reported whether obesity is associated with early vascular aging(EVA).This study aims to explore the correlation between obesity and EVA in middle-aged and young adult health check-up populations,providing a reference for the prevention of cardiovascular diseases.Methods:A total of 15464 middle-aged and young adults aged 18−59 who completed brachial-ankle pulse wave velocity(baPWV)test in the Third Xiangya Hospital of Central South University from January to December 2020 were included.Among them,1965 individuals with normal blood pressure and no cardiovascular risk factors were selected as the healthy population.The baPWV thresholds for determining EVA in each age group for males and females were calculated based on the baPWV values of the healthy population.The number and percentage of individuals meeting the EVA criteria in the middle-aged and young adult health check-up populations were statistically analyzed by age and gender.The differences in obesity indicators[visceral adiposity index(VAI),body mass index(BMI),waist circumference(WC)]between the EVA and non-EVA groups for males and females were compared.Using EVA as the dependent variable,VAI,BMI,and WC were included as independent variables in a Logistic model to analyze the correlation between each obesity indicator and EVA before and after adjusting for other influencing factors.Furthermore,the correlation between each obesity indicator and EVA in each age group was analyzed.Results:In the health check-up populations,the detection rate of EVA in different age groups was 1.65%−10.92%for males,and 1.16%−10.50%for females,the detection rate of EVA increased with age in both males and females.Except for the 40−<50 age group,the EVA detection rate was higher in males than in females in all other age groups.Regardless of gender,obesity indicators VAI,BMI,and WC were significantly higher in the EVA group than in the non-EVA group(all P<0.01).Before and after adjusting for other influencing factors,VAI and WC were both correlated with EVA(both P<0.05).BMI was a risk factor for EVA before adjusting for other influencing factors(P<0.01),but after adjustment,the correlation between BMI and EVA was not statistically significant(P=0.05).After adjusting for other influencing factors,the correlation between VAI and EVA was statistically significant in the 18−<40 and 50−<60 age groups(both P<0.05),while the correlation between BMI and WC with EVA was not statistically significant(both P>0.05).In the 40−<50 age group,the correlation between VAI and BMI with EVA was not statistically significant(both P>0.05),but the correlation between WC and EVA was statistically significant(P<0.01).Conclusion:VAI is closely related to the occurrence of EVA in middle-aged and young adults aged 18−<40 and 50−<60 years,while WC is closely related to the occurrence of EVA in those aged 40−<50 years.