Measures of Adiposity and Future Risk of Ischemic Stroke and Coronary Heart Disease in Older Men and Women
Measures of Adiposity and Future Risk of Ischemic Stroke and Coronary Heart Disease in Older Men and Women
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DOI：
10.1093/aje/kwq311
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发表时间：
2011-01-01
影响因子：
5
通讯作者：
Siscovick, David S.
中科院分区：
文献类型：
--
作者：
Kizer, Jorge R.;Biggs, Mary L.;Siscovick, David S.
在老年人中，全身性肥胖和中心性肥胖的测量与个体心血管终点之间的关系仍未得到充分研究。本研究调查了 3,754 名 65-100 岁社区居住的美国成年人的体型和成分测量值与缺血性中风或冠心病（1989-2007 年）之间的关系。在基线时获得标准化的人体测量学和生物电阻抗测量值。根据回忆体重计算 50 岁时体重指数 (BMI50)。虽然在女性五分位数分析中只有腰臀比与缺血性卒中显着相关，但二分体重指数 (BMI) (>= 30 kg/m(2)) 是男性唯一显着的预测因子。对于冠心病，所有肥胖指标均存在显着的正调整关联，且不存在性别交互作用。对于肥胖的五分位数和传统切点来说都是如此，尽管 BMI 定义的超重 (25-29.9 kg/m(2)) 在中年时很显着，但在基线时则不然。极端五分位数（五分位数 5 与五分位数 1）的关联强度大致相当，但最高效应估计是腰臀比（风险比 = 1.56，95% 置信区间：1.25、1.94）和 BMI50（风险比 = 1.71，95% 置信区间：1.37、2.14），这两者在调整中介因素后仍然显着， BMI，或彼此。这些差异是否转化为更好的风险预测将需要荟萃分析方法，以及预后切点的确定。
The relation between measures of general and central adiposity and individual cardiovascular endpoints remains understudied in older adults. This study investigated the association of measures of body size and composition with incident ischemic stroke or coronary heart disease (1989-2007) in 3,754 community-dwelling US adults aged 65-100 years. Standardized anthropometry and bioelectric impedance measurements were obtained at baseline. Body mass index at age 50 years (BMI50) was calculated on the basis of recalled weight. Although only waist/hip ratio was significantly associated with ischemic stroke in quintile analysis in women, dichotomized body mass index (BMI) (>= 30 kg/m(2)) was the only significant predictor in men. For coronary heart disease, there were significant positive adjusted associations for all adiposity measures, without interaction by sex. This was true for both quintiles and conventional cutpoints for obesity, although BMI-defined overweight (25-29.9 kg/m(2)) was significant at midlife but not at baseline. Strengths of association for extreme quintiles (quintile 5 vs. quintile 1) were broadly comparable, but the highest effect estimates were for waist/hip ratio (hazard ratio = 1.56, 95% confidence interval: 1.25, 1.94) and BMI50 (hazard ratio = 1.71, 95% confidence interval: 1.37, 2.14), both of which remained significant after adjustment for mediators, BMI, or each other. Whether these differences translate to better risk prediction will require meta-analytical approaches, as will determination of prognostic cutpoints.