腰臀比纵向轨迹与动脉硬化的关联性
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摘要
目的探讨腰臀比纵向轨迹与动脉硬化的关联。方法研究队列由开滦卒中队列、老年人群队列、妊娠队列和外周血管疾病筛查队列组成,其中符合入选标准的研究对象共9080名。通过SAS Proc Traj程序确定观察对象2006-2007、2008-2009、2010-2011年健康体检的腰臀比纵向轨迹,生成4组不同的腰臀比轨迹组:低-中轨迹组、中-稳定轨迹组、高-高轨迹组、高-中轨迹组,并于2010-2015年对观察对象进行了肱踝动脉脉搏波传导速度(baPWV)检测。采用协方差分析校正了年龄、性别后不同腰臀比纵向轨迹分组baPWV的差异。采用多因素Logistic回归模型分析腰臀比纵向轨迹与动脉硬化的关联。定义baPWV≥1400cm/s为动脉硬化。结果与其他腰臀比轨迹组相比,高-高轨迹组的baPWV值[(1545.56±4.31)cm/s]、动脉硬化人群比例(67.5%)均最高。低-中轨迹组、中-稳定轨迹组、高-高轨迹组、高-中轨迹组动脉硬化的发生率分别为:28.8%、50.0%、67.5%、55.4%。在多因素Logistic回归分析中,校正了其他混杂因素后,与低-中轨迹组相比,中-稳定轨迹组、高-高轨迹组、高-中轨迹组是动脉硬化发生的危险因素,对应的OR值(95%CI)分别为1.42(1.15~1.76)、1.80(1.42~2.29)、1.63(1.11~2.38),均P<0.05。此外,分别除外服用降压药、降糖药、降脂药人群后进行了敏感性分析,结果与主要研究结果趋势一致。结论腰臀比纵向轨迹水平升高是发生动脉硬化的危险因素。
Objective To explore the correlation of waist-to-hip ratio trajectories and arteial stiffness.Methods The study cohort consisted of 4cohorts(the Stroke Cohort,the Elderly Cohort,the Pregnancy Cohort and the Peripheral Vascular Disease Screening Cohort,respectively). A total of 9080 participants met the inclusion criteria and enrolled in the study. SAS Proc Traj procedure was used to identify trajectories in waist-to-hip ratio throughout 2006-2007 to 2010-2011 examinations. The 4trajectories were low-moderate group,moderate-stable group,elevated-increasing group and elevated-lowering group. The participants underwent the brachial-ankle pulse wave velocity(baPWV)examination during 2010-2015. Covariance analysis model,adjusted the age and gender,was used to analyze the difference of baPWV among 4groups. Logistic regression models were used to analyze the influence of waist-to-hip ratio trajectories on arterial stiffness. BaPWV≥1400cm/s was defined as arterial stiffness.Results Both baPWV value [(1545.56±4.31)cm/s]and proportion of population with arterial stiffness(67.5%)in elevated-increasing group were the highest. The corresponding incidence of arterial stiffness in lowmoderate group,moderate-stable group,elevated-increasing group and elevated-lowering group were 28.8%,50.0%,67.5% and 55.4% respectively. Logistic regression analysis showed that compared to the low-stable group,the moderate-stable group,elevated-increasing group and elevated-lowering group were still risk factors of arterial stiffness after adjusting for baseline risk factors,OR(95% CI)were 1.42(1.15-1.76),1.80(1.42-2.29)and 1.63(1.11-2.38),respectively(all P<0.05). The results of sensitivity analyses,which rule out separately the participants who taking antihypertensive agents,hypoglycemic drugs and lipid-lowering drugs,were similar to the results of the non-sensitivity analyses. Conclusion The elevated levels of waist-to-hip ratio trajectories is one of risk factors of arterial stiffness.
Objective To explore the correlation of waist-to-hip ratio trajectories and arteial stiffness.Methods The study cohort consisted of 4cohorts(the Stroke Cohort,the Elderly Cohort,the Pregnancy Cohort and the Peripheral Vascular Disease Screening Cohort,respectively). A total of 9080 participants met the inclusion criteria and enrolled in the study. SAS Proc Traj procedure was used to identify trajectories in waist-to-hip ratio throughout 2006-2007 to 2010-2011 examinations. The 4trajectories were low-moderate group,moderate-stable group,elevated-increasing group and elevated-lowering group. The participants underwent the brachial-ankle pulse wave velocity(baPWV)examination during 2010-2015. Covariance analysis model,adjusted the age and gender,was used to analyze the difference of baPWV among 4groups. Logistic regression models were used to analyze the influence of waist-to-hip ratio trajectories on arterial stiffness. BaPWV≥1400cm/s was defined as arterial stiffness.Results Both baPWV value [(1545.56±4.31)cm/s]and proportion of population with arterial stiffness(67.5%)in elevated-increasing group were the highest. The corresponding incidence of arterial stiffness in lowmoderate group,moderate-stable group,elevated-increasing group and elevated-lowering group were 28.8%,50.0%,67.5% and 55.4% respectively. Logistic regression analysis showed that compared to the low-stable group,the moderate-stable group,elevated-increasing group and elevated-lowering group were still risk factors of arterial stiffness after adjusting for baseline risk factors,OR(95% CI)were 1.42(1.15-1.76),1.80(1.42-2.29)and 1.63(1.11-2.38),respectively(all P<0.05). The results of sensitivity analyses,which rule out separately the participants who taking antihypertensive agents,hypoglycemic drugs and lipid-lowering drugs,were similar to the results of the non-sensitivity analyses. Conclusion The elevated levels of waist-to-hip ratio trajectories is one of risk factors of arterial stiffness.
引文
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[19]Xu W,Zhang H,Paillard-Borg S,et al.Prevalence of overweight and obesity among Chinese adults:role of adiposity indicators and age[J].Obes Facts,2016,9(1):17-28.
[20]Szulc P,Duboeuf F,Chapurlat R.Age-related changes in fat mass and distribution in men-the cross-sectional STRAMBO study[J].J Clin Densitom,2016,pii:S1094-6950(16)30105-30106.
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[22]Wanner M,Martin BW,Autenrieth CS,et al.Associations between domains of physical activity,sitting time,and different measures of overweight and obesity[J].Prev Med Rep,2016,3:177-184.
[23]Niyonkuru C,Wagner AK,Ozawa H,et al.Group-based trajectory analysis applications for prognostic biomarker model development in severe TBI:apractical example[J].J Neurotramua,2013,30(11):938-945.
[24]Nagin DS.Analyzing developmental trajectories:a semiparametric,group based approach[J].Psychol Methods,1999,4(2):139-157.
[25]Song M,Willett WC,Hu FB,et al.Trajectory of body shape across the lifespan and cancer risk[J].Int J Cancer,2016,138(10):2383-2395.
[26]Song M,Hu FB,Wu K,et al.Trajectory of body shape in early and middle life and all cause and cause specific mortality:results from two prospective US cohort studies[J].BMJ,2016,4:353:i2195.
[27]国家统计局人口和就业统计司.中国人口统计年鉴(2006)[M].中国统计出版社,2006:74-76.
[28]赵海燕,陈兴伟,牛建清,等.妊娠高血压综合征对远期心脑血管事件的影响[J].中华心血管病杂志,2012,40(8):645-651.
[29]赵华灵,刘秀荣,王洋,等.老年人群诊室、随诊间、24h动态收缩压与肱踝动脉脉搏波传导速度的相关性[J].中华高血压杂志,2015,23(9):851-856.
[30]Wu SL,Huang ZR,Yang XC,et al.Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a northern Chinese industrial city[J].Circ Cardiovasc Qual Outcomes,2012,5(4):487-493.
[31]Yamashina A,Tomiyama H,Arai T,et al.Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk[J].Hypertens Res,2003,26(8):615-622.
[32]Nagin DS,Odgers CL.Group-based trajectory modeling in clinical research.Annual review of clinical psychology[J].Annu Rev Clin Psychol,2010,6(4):109-138.
[33]Jones BL,Nagin D,Roeder K.A SAS procedure based on mixture model for estimating developmental trajectories[J].Sociol Meth Res,2001,29(3):374-393.
[34]Wildman RP,Mackey RH,Bostom A,et al.Measures of obesity are associated with cascular stiffness in young and older adults[J].Hypertension,2003,42(4):468-473.
[35]Bastard JP,Maachi M,Lagathu C,et al.Recent advances in the relationship between obesity,inflammation,and insulin resistance[J].Eur Cytokine Netw,2006,17(1):4-12.
[36]Artunc F,Schleicher E,Weigert C,et al.The impact of insulin resistance on the kidney and vasculature[J].Nat Rev Nephrol,2016,12(12):721-737.
[37]Landsberg L.Feast or famine:the sympathetic nervous system response to nutrient intake[J].Cell Mol Neurobiol,2006,26(4/6):497-508.
[38]Begum N,Song Y,Rienzie J,et al.Vascular smooth muscle cell growth and insulin regulation of mitogen-activated protein kinase in hypertension[J].Am J Physiol,1998,275(1pt 1):C42-C49.
[39]Ulrich P,Cerami A.Protein glycation,diabetes,and aging[J].Recent Prog Horm Res,2001,56(1):1-21.
[40]Weyer C,Yudkin JS,Stehouwer CD,et al.Humoral markers of inflammation and endothelial dysfunction in relation to adiposity and in vivo insulin action in Pima Indians[J].Atherosclerosis,2002,161(1):233-242.
[41]Oda A,Taniguchi T,Yokoyama M.Leptin stimulates rat aortic smooth muscle cell proliferation and migration[J].Kobe J Med Sci,2001,47(3):141-150.
[42]Ghantous CM,Azrak Z,Hanache S,et al.Differential role of leptin and adiponectin in cardiovascular system[J].Int J Endocrinol,2015,2015:534320.
[2]Mitchell GF,Hwang SJ,Vasan RS,et al.Arterial stiffness and cardiovascular events:the Framingham heart study[J].Circulation,2010,121(4):505-511.
[3]Mattace-Rasp FU,Vander Cammen TJ,Hofman A,et al.Arterial stiffness and risk of coronary heart disease and stroke:the Rotterdam study[J].Ciculation,2006,113(5):657-663.
[4]Sedaqhat S,Mattace-Raso FU,Hoorn EJ,et al.Arterial stiffness and decline in kidney function[J].Clin J Am Soc Nephrol,2015,10(12):2190-2197.
[5]Taniguchi Y,Fujiwara Y,Nofuji Y,et al.Prospective study of arterial stiffness and subsequent cognitive decline among community-dwelling older Japanese[J].J Epidemiol,2015,25(9):592-599.
[6]Vlachopoulos C,Aznaouridis K,Stefanadis C.Prediction of cardiovascular events and all-cause mortality with arterial stiffness:a systematic review and meta-analysis[J].J Am Coll Cardiol,2010,55(13):1318-1327.
[7]Lin LY,Liao YC,Lin HF,et al.Determinants of arterial stiffness progression in a Han-Chinese population in Taiwan:a 4-year longitudinal follow-up[J].BMC Cardiovasc Disord,2015,15:100.
[8]Sun Z.Aging,arterial stiffness,and hypertension[J].Hypertension,2015,65(2):252-256.
[9]Ljunggren P,Maahs DM,Johansson P,et al.Reduced brachial artery distensibility in patients with type 1diabetes[J].J Diabetes Complications,2016,pii:S1056-8727(16)30041-1.
[10]Li X,Deng YP,Yang M,et al.Low-grade inflammation and increased arterial stiffness in Chinese youth and adolescents with newly-diagnosed type 2diabetes mellitus[J].J Clin Res Pediatr Endocrinol,2015,7(4):268-273.
[11]Dobsak P,Soska V,Sochor O,et al.Increased cardio-ankle vascular index in hyperlipidemic patients without diabetes or hypertension[J].J Atheroscler Thromb,2015,22(3):272-283.
[12]Wilson PW,D'Agostino RB,Sullivan L,et al.Overweight and obesity as determinants of cardiovascular risk:the Framingham experience[J].Arch Intern Med,2002,162(16):1867-1872.
[13]Poirier P,Giles TD,Bray GA,et al.Obesity and cardiovascular isease:pathophysiology,evaluation,and effect of weight loss[J].Arterioscler Thromb Vasc Biol,2006,26(5):968-976.
[14]Zhu S,Wang Z,Heshka S,et al.Waist circumference and obesity-associated risk factors among whites in the third national health and nutrition examination survey:clinical action thresholds[J].Am J Clin Nutr,2002,76(4):743-749.
[15]Wohlfart P,Somers VK,Cifkova R,et al.Relationship between measures of central and general adiposity with aortic stiffness in the general population[J].Atherosclerosis,2014,235(2):625-631.
[16]Canepa M,AlGhatrif M,Pestellli G,et al.Impact of central obesity on the estimation of carotid-femoral pulse wave velocity[J].Am J Hypertens,2014,27(9):1209-1217.
[17]Nishida C,Ko GT,Kumanyika S.Body fat distribution and noncommunicable diseases in populations:overview of the 2008WHO expert consultation on waist circumference and waist-hip ratio[J].Eur J Clin Nutr,2010,64(1):2-5.
[18]Brunner EJ,Shipley MJ,Ahmadi-Abhari S,et al.Asiposity,obesity and arterial aging:longitudinal study of aortic stiffness in the WhitehallⅡcohort[J].Hypertension,2015,66(2):294-300.
[19]Xu W,Zhang H,Paillard-Borg S,et al.Prevalence of overweight and obesity among Chinese adults:role of adiposity indicators and age[J].Obes Facts,2016,9(1):17-28.
[20]Szulc P,Duboeuf F,Chapurlat R.Age-related changes in fat mass and distribution in men-the cross-sectional STRAMBO study[J].J Clin Densitom,2016,pii:S1094-6950(16)30105-30106.
[21]Rolland-Cachera MF,Akrout M,Péneau S.Nutrient intakes in early life and risk of obesity[J].Int J Environ Res Public Health,2016,13(6):pii:E564.
[22]Wanner M,Martin BW,Autenrieth CS,et al.Associations between domains of physical activity,sitting time,and different measures of overweight and obesity[J].Prev Med Rep,2016,3:177-184.
[23]Niyonkuru C,Wagner AK,Ozawa H,et al.Group-based trajectory analysis applications for prognostic biomarker model development in severe TBI:apractical example[J].J Neurotramua,2013,30(11):938-945.
[24]Nagin DS.Analyzing developmental trajectories:a semiparametric,group based approach[J].Psychol Methods,1999,4(2):139-157.
[25]Song M,Willett WC,Hu FB,et al.Trajectory of body shape across the lifespan and cancer risk[J].Int J Cancer,2016,138(10):2383-2395.
[26]Song M,Hu FB,Wu K,et al.Trajectory of body shape in early and middle life and all cause and cause specific mortality:results from two prospective US cohort studies[J].BMJ,2016,4:353:i2195.
[27]国家统计局人口和就业统计司.中国人口统计年鉴(2006)[M].中国统计出版社,2006:74-76.
[28]赵海燕,陈兴伟,牛建清,等.妊娠高血压综合征对远期心脑血管事件的影响[J].中华心血管病杂志,2012,40(8):645-651.
[29]赵华灵,刘秀荣,王洋,等.老年人群诊室、随诊间、24h动态收缩压与肱踝动脉脉搏波传导速度的相关性[J].中华高血压杂志,2015,23(9):851-856.
[30]Wu SL,Huang ZR,Yang XC,et al.Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a northern Chinese industrial city[J].Circ Cardiovasc Qual Outcomes,2012,5(4):487-493.
[31]Yamashina A,Tomiyama H,Arai T,et al.Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk[J].Hypertens Res,2003,26(8):615-622.
[32]Nagin DS,Odgers CL.Group-based trajectory modeling in clinical research.Annual review of clinical psychology[J].Annu Rev Clin Psychol,2010,6(4):109-138.
[33]Jones BL,Nagin D,Roeder K.A SAS procedure based on mixture model for estimating developmental trajectories[J].Sociol Meth Res,2001,29(3):374-393.
[34]Wildman RP,Mackey RH,Bostom A,et al.Measures of obesity are associated with cascular stiffness in young and older adults[J].Hypertension,2003,42(4):468-473.
[35]Bastard JP,Maachi M,Lagathu C,et al.Recent advances in the relationship between obesity,inflammation,and insulin resistance[J].Eur Cytokine Netw,2006,17(1):4-12.
[36]Artunc F,Schleicher E,Weigert C,et al.The impact of insulin resistance on the kidney and vasculature[J].Nat Rev Nephrol,2016,12(12):721-737.
[37]Landsberg L.Feast or famine:the sympathetic nervous system response to nutrient intake[J].Cell Mol Neurobiol,2006,26(4/6):497-508.
[38]Begum N,Song Y,Rienzie J,et al.Vascular smooth muscle cell growth and insulin regulation of mitogen-activated protein kinase in hypertension[J].Am J Physiol,1998,275(1pt 1):C42-C49.
[39]Ulrich P,Cerami A.Protein glycation,diabetes,and aging[J].Recent Prog Horm Res,2001,56(1):1-21.
[40]Weyer C,Yudkin JS,Stehouwer CD,et al.Humoral markers of inflammation and endothelial dysfunction in relation to adiposity and in vivo insulin action in Pima Indians[J].Atherosclerosis,2002,161(1):233-242.
[41]Oda A,Taniguchi T,Yokoyama M.Leptin stimulates rat aortic smooth muscle cell proliferation and migration[J].Kobe J Med Sci,2001,47(3):141-150.
[42]Ghantous CM,Azrak Z,Hanache S,et al.Differential role of leptin and adiponectin in cardiovascular system[J].Int J Endocrinol,2015,2015:534320.