绝经后妇女血浆致动脉粥样硬化指数与心血管病风险的关系及其对高危心血管病的预测价值

The Relationship Between Atherogenic Index of Plasma and Cardiovascular Disease Risk in Postmenopausal Women and its Predictive Value for Cardiovascular Disease of High Risk

目的探讨绝经后妇女血浆致动脉粥样硬化指数(AIP)与弗明翰风险评分(FRS)评估的10年心血管病(CVD)风险关系,并评估AIP对绝经后妇女高危CVD的预测价值。方法选取四川省人民医院健康管理中心体检的绝经后妇女462例(绝经后妇女组)和绝经前妇女196例(绝经前妇女组)。AIP以对数形式计算[甘油三酯(TG)/高密度脂蛋白胆固醇(HDL-C)],运用FRS评估CVD风险,并根据FRS得分将绝经后妇女分为CVD低危组(307例)和高危组(155例)。分析AIP与变量及FRS间的关系,分析绝经后妇女高危CVD的影响因素,采用受试者工作特征(ROC)曲线分析AIP对绝经后妇女高危CVD的预测价值。结果与绝经前妇女相比,绝经后妇女的年龄、BMI、收缩压、舒张压、TG、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、HDL-C、空腹血糖、AIP和FRS均显著升高(均P<0.05)。同时,绝经后妇女中吸烟、患有高血压、糖尿病及高危FRS的比例均明显增加(均P<0.05)。Pearson相关分析显示AIP与年龄、BMI、收缩压、舒张压、LDL-C及FRS均呈正相关,进一步多元线性回归分析发现绝经后妇女AIP与FRS独立相关(β=0.433,P<0.001)。多因素Logistic回归分析提示,在调整混杂因素后,AIP仍是绝经后妇女高危CVD的独立危险因素(OR 7.301,95%CI 2.469~15.668,P<0.001)。ROC曲线分析表明,AIP预测绝经后妇女高危CVD的曲线下面积为0.868(95%CI 0.836~0.900),最佳截断值为-0.035,敏感度和特异度分别为88.47%和81.23%。结论绝经后妇女的AIP较绝经前妇女明显升高并与CVD风险密切相关,且AIP可用于有效预测绝经后妇女的高危CVD风险。

Objective To explore the relationship between atherogenic index of plasma(AIP)and 10-year cardiovascular disease(CVD)risk assessed by the Framingham Risk Score(FRS)in postmenopausal women,and to evaluate predictive value of AIP for high-risk CVD in postmenopausal women.Methods Total 462 postmenopausal women(postmenopausal women group)and 196 premenopausal women(premenopausal women group)undergoing physical examination were selected.AIP was calculated in logarithmic form[triglyceride(TG)/high-density lipoprotein cholesterol(HDL-C)].FRS was used to assess CVD risk,and postmenopausal women were divided into low-risk CVD group(307 cases)and high-risk group(155 cases)based on FRS scores.Analyze relationship between AIP and variables as well as FRS,influencing factors of high-risk CVD in postmenopausal women.The predictive value of AIP for high-risk CVD in postmenopausal women was analyzed using receiver operating characteristic(ROC)curves.Results Compared with premenopausal women,postmenopausal women had significantly higher age,BMI,systolic blood pressure,diastolic blood pressure,TG,total cholesterol,low-density lipoprotein cholesterol(LDL-C),HDL-C,fasting blood glucose,AIP,and FRS(all P<0.05).Meanwhile,proportions of smoking,hypertension,diabetes,and high-risk FRS were significantly increased in postmenopausal women(all P<0.05).Pearson correlation analysis showed that AIP was positively correlated with age,BMI,systolic blood pressure,diastolic blood pressure,LDL-C,and FRS.Further multiple linear regression analysis found that AIP was independently correlated with FRS in postmenopausal women(β=0.433,P<0.001).Multivariate Logistic regression analysis suggested that AIP remained an independent risk factor for high-risk CVD in postmenopausal women after adjusting for confounding factors(OR 7.301,95%CI 2.469~15.668,P<0.001).ROC curve analysis showed that the area under the curve for AIP predicting high-risk CVD in postmenopausal women was 0.868(95%CI 0.836~0.900),with an optimal cutoff value of-0.035,sensitivity of 88.47%,and specificity of 81.23%.Conclusion AIP of postmenopausal women would be significantly higher than that before menopause and would be closely related to CVD risk.AIP could be used to effectively predict high-risk CVD in postmenopausal women.