DXA Versus Clinical Measures of Adiposity as Predictors of Cardiometabolic Diseases and All-Cause Mortality in Postmenopausal Women.
DXA Versus Clinical Measures of Adiposity as Predictors of Cardiometabolic Diseases and All-Cause Mortality in Postmenopausal Women.
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DOI：
10.1016/j.mayocp.2021.04.027
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发表时间：
2021-11
影响因子：
8.9
通讯作者：
Assimes TL
中科院分区：
文献类型：
--
作者：
Laddu DR;Qin F;Hedlin H;Stefanick ML;Manson JE;Zaslavsky O;Eaton C;Martin LW;Rohan T;Assimes TL
研究DXA对肥胖的评估是否优于传统的替代物，体重指数（BMI），腰围（WC）和腰臀比（WHR），在老年女性中改善心脏代谢疾病的风险预测。我们分析了多达9，744名年龄在50-79岁之间的绝经后妇女，这些妇女参加了妇女健康倡议，接受了DXA扫描，基线（1993年10月至1998年12月）没有CVD和糖尿病，并随访至2015年9月。将基线BMI、WC、WHR、DXA衍生的全身百分比（%BF）和躯干脂肪（%TrF）纳入多变量考克斯比例风险模型，以估计糖尿病、动脉粥样硬化相关心血管疾病（ASCVD）、心力衰竭（HF）和死亡的风险。一致性概率估计（CPE）评估了肥胖指标对之间的相对判别值。在长达17.2年的中位随访期间，共有1327例糖尿病病例，1266例ASCVD病例，292例HF病例和1811例任何原因的死亡。肥胖指标每增加1个标准差观察到的最大风险比为%TrF和糖尿病（1.77，95% CI 1.66-1.88），其次为%TrF和广义ASCVD（1.22，95% CI 1.15-1.30）。即使在调整了肥胖的最佳传统替代指标WC后，糖尿病（1.47，95%CI 1.37-1.57）和ASCVD（1.22，95%CI 1.14-1.31）的风险比仍然显著。%TrF也是唯一的肥胖指标，证明糖尿病和ASCVD的CPE相对于BMI、WC和WHR的统计学显著改善（所有p<0.05）。DXA对绝经后妇女腹部肥胖的评估可能会大大改善对糖尿病风险的预测，超过标准的临床风险模型。在得出确切的结论之前，需要进行更大规模的DXA研究，包括完整的脂质生物标志物谱和临床试验。
To investigate whether DXA estimates of adiposity improve risk prediction for cardiometabolic diseases over traditional surrogates, body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR), in older women. We analyzed up to 9,744 post-menopausal women aged 50–79 years participating in the Women’s Health Initiative who underwent a DXA scan and were free of CVD and diabetes at baseline (October 1993 to December 1998) and followed through September 2015. Baseline BMI, WC, WHR, DXA-derived percent total-body (%BF) and trunk fat (%TrF) were incorporated into multivariable Cox proportional-hazard models to estimate the risk of incident diabetes, atherosclerosis-related cardiovascular diseases (ASCVD), heart failure (HF), and death. Concordance probability estimates (CPE) assessed the relative discriminatory value between pairs of adiposity measures. A total of 1327 diabetes cases, 1266 ASCVD cases, 292 HF cases, and 1811 deaths from any cause accrued during a median follow-up of up to 17.2 years. The largest hazard ratio observed per 1 standard deviation increase of an adiposity measure was for %TrF and diabetes (1.77, 95% CI 1.66–1.88) followed by %TrF and broadly defined ASCVD (1.22, 95% CI 1.15–1.30). These hazard ratios remained significant for both diabetes (1.47, 95% CI 1.37–1.57) and ASCVD (1.22, 95% CI 1.14–1.31) even after adjusting for the best traditional surrogate measure of adiposity, WC. %TrF was also the only adiposity measure to demonstrate statistically significant improved CPE over BMI, WC, and WHR for diabetes and ASCVD (all p<0.05). DXA-derived estimates of abdominal adiposity in post-menopausal women may allow for substantially improved risk prediction of diabetes over standard clinical risk models. Larger DXA studies with complete lipid biomarker profiles and clinical trials are needed before firm conclusions can be made.
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