饮酒频率与心血管病高危风险的关联分析
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摘要
目的探索饮酒频率对心血管病(CVD)高危风险的影响,为限制饮酒预防CVD高危风险提供研究依据。方法本研究数据来源于2016年中国心血管病高危人群筛查与综合干预项目江苏省数据库,采用倾向性得分匹配的最近邻匹配法为每个CVD高危对象匹配一个倾向性得分相近的非CVD高危对象。问卷调查人口社会学信息、饮酒频率和CVD风险因素,并进行体格检查和生化指标测定。采用SPSS 23.0进行t检验、χ~2检验和多因素logistic回归分析。结果共31 605例对象纳入本研究,其中CVD高危对象15 948例,非CVD高危对象15 657例。多因素logistic回归分析结果显示,饮酒将增加CVD高危风险(OR=1.06,95%CI:1.04～1.08);不同饮酒频率比较发现,与从不饮酒相比,饮酒≤1次/月可降低CVD高危风险(OR=0.89,95%CI:0.79～1.00),饮酒2～3次/周(OR=1.14,95%CI:1.00～1.29)和≥4次/周(OR=1.30,95%CI:1.21～1.41)可增加CVD高危风险,均有统计学意义(P<0.05,P<0.01)。分层分析结果显示,饮酒是男性CVD高危的危险因素(OR=1.05,95%CI:1.03～1.07),却是女性的保护因素(OR=0.87,95%CI:0.82～0.92)。异质性检验结果显示,饮酒频率与CVD高危的关联性在不同性别间存在异质性(P<0.01)。交互作用结果显示,饮酒频率与性别在对CVD高危作用中存在交互作用,有统计学意义(P<0.01)。结论不同饮酒频率人群的CVD高危发生率呈"U"型分布。性别是饮酒频率致CVD高危的效应修饰因素;饮酒频率与性别在对CVD高危作用中存在交互作用。
Objective To explore the effects of drinking frequency on the high-risk of cardio-vascular disease(CVD),and to provide the research basis for CVD high-risk prevention of restricting alcohol. Methods The data were from the database of Jiangsu Province in China PEACE(Patient-centered Evaluative Assessment of Cardiac Events) Million Persons Project. The nearest neighbor matching method in Propensity Score Matching(PSM) was used to construct a case-control study to explore the differences of CVD high-risk among people with different drinking frequencies. The demographic and sociological information,drinking frequency and other risk factors of CVD were collected by questionnaire investigation and physical examination. The t test,χ~2 test and multivariate logistic regression method were used to analyze the data,the used software was SPSS 23.0. Results The study included 31 605 subjects,15 948 cases were the CVD high risk subjects,15 657 cases were the non-CVD high risk subjects. Multivariate logistic regression analysis showed that drinking increased the risk of CVD high-risk(OR=1.06,95%CI:1.04-1.08). Compared with non-drinking,the drinking ≤1 time/month could reduce the high-risks of CVD(OR=0.89,95%CI:0.79-1.00),the drinking 2~3 times/week and drinking ≥4 times/week could increase the high-risks of CVD(OR=1.14,95%CI:1.00-1.29) and(OR=1.30,95%CI:1.21-1.41),respectively,P<0.05 or P<0.01. Stratified analysis showed that the drinking was a risk factor of male CVD high-risk(OR=1.05,95%CI:1.03-1.07),and a protective factor of female CVD high-risk(OR=0.87,95%CI:0.82-0.92). The heterogeneity test showed that there was a heterogeneity in association of drinking frequency with CVD high risk for different gender subjects(P<0.01). The interaction effect showed that there was an interaction effect in the effects of drinking frequency and gender on CVD high risk(P<0.01). Conclusion The morbidity of CVD high-risk in subjects with different drinking frequencies showed U-shaped distribution. Gender was an effect modification factor of drinking frequency on the CVD high-risk. There was an interaction effect in the effects of drinking frequency and gender on CVD high risk.
Objective To explore the effects of drinking frequency on the high-risk of cardio-vascular disease(CVD),and to provide the research basis for CVD high-risk prevention of restricting alcohol. Methods The data were from the database of Jiangsu Province in China PEACE(Patient-centered Evaluative Assessment of Cardiac Events) Million Persons Project. The nearest neighbor matching method in Propensity Score Matching(PSM) was used to construct a case-control study to explore the differences of CVD high-risk among people with different drinking frequencies. The demographic and sociological information,drinking frequency and other risk factors of CVD were collected by questionnaire investigation and physical examination. The t test,χ~2 test and multivariate logistic regression method were used to analyze the data,the used software was SPSS 23.0. Results The study included 31 605 subjects,15 948 cases were the CVD high risk subjects,15 657 cases were the non-CVD high risk subjects. Multivariate logistic regression analysis showed that drinking increased the risk of CVD high-risk(OR=1.06,95%CI:1.04-1.08). Compared with non-drinking,the drinking ≤1 time/month could reduce the high-risks of CVD(OR=0.89,95%CI:0.79-1.00),the drinking 2~3 times/week and drinking ≥4 times/week could increase the high-risks of CVD(OR=1.14,95%CI:1.00-1.29) and(OR=1.30,95%CI:1.21-1.41),respectively,P<0.05 or P<0.01. Stratified analysis showed that the drinking was a risk factor of male CVD high-risk(OR=1.05,95%CI:1.03-1.07),and a protective factor of female CVD high-risk(OR=0.87,95%CI:0.82-0.92). The heterogeneity test showed that there was a heterogeneity in association of drinking frequency with CVD high risk for different gender subjects(P<0.01). The interaction effect showed that there was an interaction effect in the effects of drinking frequency and gender on CVD high risk(P<0.01). Conclusion The morbidity of CVD high-risk in subjects with different drinking frequencies showed U-shaped distribution. Gender was an effect modification factor of drinking frequency on the CVD high-risk. There was an interaction effect in the effects of drinking frequency and gender on CVD high risk.
引文
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[24]Lucas DL,Brown RA,Wassef M,et al.Alcohol and the cardiovascular system:research challenges and opportunities[J].J Am Coll Cardiol,2005,45(12):1916-1924.
[2]Chiva-Blanch G,Arranz S,Lamuela-Raventos RM,et al.Effects of wine,alcohol and polyphenols on cardiovascular disease risk factors:evidences from human studies[J].Alcohol Alcohol,2013,48(3):270-277.
[3]Gardner JD,Mouton AJ.Alcohol effects on cardiac function[J].Compr Physiol,2015,5(2):791-802.
[4]World Health Orgnization.Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia:report of a WHO/IDFconsultation,2006[M].Geneva:WHO Document Production Services,2006:1-3.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[6]World Health Organization.Prevention of cardiovascular disease.Guidelines for assessment and management of cardiovascular risk[J].Tetrahedron Letters,2007,54(22):2817-2820.
[7]Higgins JP,Thompson SG.Quantifying heterogeneity in a metaanalysis[J].Stat Med,2002,21(11):1539-1558.
[8]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2017》概要[J].中国循环杂志,2018,33(1):1-8.
[9]Ikehara S,Iso H,Toyoshima H,et al.Alcohol consumption and mortality from stroke and coronary heart disease among Japanese men and women:the Japan collaborative cohort study[J].Stroke,2008,39(11):2936-2942.
[10]Mukamal KJ,Conigrave KM,Mittleman MA,et al.Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men[J].N Engl J Med,2003,348(2):109-118.
[11]O’Keefe JH,Bybee KA,Lavie CJ.Alcohol and cardiovascular health:the razor-sharp double-edged sword[J].J Am Coll Cardiol,2007,50(11):1009-1014.
[12]Hashimoto Y,Futamura A,Nakarai H,et al.Effects of the frequency of alcohol intake on risk factors for coronary heart disease[J].Eur JEpidemiol,2001,17(4):307-312.
[13]王玉华,戴胜燕.饮酒对心血管病的作用评价[J].河北医药,2011,33(16):2510-2512.
[14]Hines LM,Stampfer MJ,Ma J,et al.Genetic variation in alcohol dehydrogenase and the beneficial effect of moderate alcohol consumption on myocardial infarction[J].N Engl J Med,2001,344(8):549-555.
[15]Mukamal KJ,Mackey RH,Kuller LH,et al.Alcohol consumption and lipoprotein subclasses in older adults[J].J Clin Endocrinol Metab,2007,92(7):2559-2566.
[16]Vogel RA.Vintners and vasodilators:are French red wines more cardioprotective?[J].J Am Coll Cardiol,2003,41(3):479-481.
[17]Umoh NA,Walker RK,Al-Rubaiee M,et al.Acute alcohol modulates cardiac function as PI3K/Akt regulates oxidative stress[J].Alcohol Clin Exp Res,2014,38(7):1847-1864.
[18]Rodriguez A,Chawla K,Umoh NA,et al.Alcohol and apoptosis:friends or foes?[J].Biomolecules,2015,5(4):3193-3203.
[19]肖丽霞,谢东明.心血管病性别差异研究进展[J].赣南医学院学报,2014,34(6):993-996.
[20]Yang SH,Liu R,Perez EJ,et al.Mitochondrial localization of estrogen receptor beta[J].Proc Natl Acad Sci USA,2004,101(12):4130-4135.
[21]Ronksley PE,Brien SE,Turner BJ,et al.Association of alcohol consumption with selected cardiovascular disease outcomes:a systematic review and meta-analysis[J].BMJ,2011,342:d671.DOI:10.1136/bmj.d671.
[22]刘品明,Shailendrasing Dosieah,郑海生,等.东亚男性饮酒与冠心病的关系[J].中华心血管病杂志,2010,38(11):1038-1044.
[23]郑海生,刘品明.适量饮酒与心血管健康[J].中华心血管病杂志,2009,37(1):84-87.
[24]Lucas DL,Brown RA,Wassef M,et al.Alcohol and the cardiovascular system:research challenges and opportunities[J].J Am Coll Cardiol,2005,45(12):1916-1924.