Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study.
Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study.
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DOI：
10.1136/heartjnl-2014-306238
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发表时间：
2015-02
期刊：
影响因子：
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通讯作者：
Folsom AR
中科院分区：
文献类型：
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作者：
Adabag S;Huxley RR;Lopez FL;Chen LY;Sotoodehnia N;Siscovick D;Deo R;Konety S;Alonso A;Folsom AR
探讨社区居民体质指数（BMI）、腰围（WC）、腰臀比（WHR）与心脏性猝死（SCD）的关系。对14941名年龄在45-64岁的男性和女性（非裔美国人和白色）参与社区动脉粥样硬化风险研究的多中心、前瞻性、队列研究的数据进行了分析。在基线（1987-1989年）评估肥胖指标。SCD由一个委员会裁定。入组时，受试者的平均年龄±SD为54±6岁（55%为女性; 26%为非洲裔美国人）。在12.6±2.5年的随访期间，发生了253例SCD（发生率为1.34/100人-年）。肥胖和SCD之间的关联因吸烟状态而异（相互作用p≤0.01）。在校正了年龄、性别、种族、研究中心和教育水平的模型中，SCD风险与非吸烟者的BMI、WC和WHR呈正相关（p<0.001），但与吸烟者无关。在非吸烟者中，WHR与SCD的相关性比BMI或WC更强（HR/SD增量（95% CI）分别为2.00（1.65 - 2.42）; 1.34（1.15 - 1.56）和1.49（1.28 - 1.74））。调整潜在介质后（高血压、糖尿病、血脂、冠心病、心力衰竭和左心室肥大），最高WHR类别中的非吸烟者（女性>0.95;男性>1.01）的SCD风险增加一倍（HR 2.03，95% CI 1.19 - 3.46;发生率1.43/1000人-年）与WHR正常的患者相比。一般肥胖与中年非吸烟个体SCD风险增加相关，由传统心血管危险因素介导。然而，中心性肥胖与SCD的独立相关途径仍有待阐明。
To examine the association of body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR) with sudden cardiac death (SCD) in community dwelling individuals. Data from a multicentre, prospective, cohort study of 14 941 men and women (African American, and white), aged 45–64 years, participating in the Atherosclerosis Risk in Communities study was analysed. Obesity measures were assessed at baseline (1987–1989). SCD was adjudicated by a committee. At enrolment mean±SD age of the participants was 54±6 years (55% female; 26% African American). During 12.6±2.5 years of follow-up, 253 SCD occurred (incidence rate 1.34/100 person-years). The association between obesity and SCD differed by smoking status (interaction p≤0.01). In models adjusting for age, sex, race, study centre and education level, SCD risk was positively associated (p<0.001) with BMI, WC and WHR in non-smokers, but not in smokers. WHR was more strongly associated with SCD in non-smokers than was BMI or WC (HR per SD increment (95% CI) 2.00 (1.65 to 2.42); 1.34 (1.15 to 1.56) and 1.49 (1.28 to 1.74), respectively). After adjustment for potential mediators (hypertension, diabetes, lipid profile, prevalent coronary heart disease, heart failure, and LV hypertrophy), non-smokers in the highest WHR category (>0.95 in women; >1.01 in men) had double the risk of SCD (HR 2.03, 95% CI 1.19 to 3.46; incidence rate 1.43/1000 person-years) versus those with normal WHR. General obesity is associated with increased risk of SCD in middle-aged, non-smoking individuals, mediated by traditional cardiovascular risk factors. Central obesity, however, is independently associated with SCD by pathways that remain to be elucidated.