社区居民肥胖、中心性肥胖与冠心病发病风险的前瞻性队列研究

目的探索肥胖、中心性肥胖与冠心病发病风险的关系。方法 2013年在上海市浦东新区社区居民中采用多阶段分层随机抽样选取人群开展基线调查,收集6 685名队列研究对象的人口学特征、暴露因素、身体测量指标等信息。随访观察中位时间3.00年,记录队列人群的冠心病发病情况。单因素分析采用t检验、Kruskal-Wallis检验和卡方检验,多因素分析采用COX比例风险模型。结果队列总计观察人年数为19 759.93人年,共有260人发生冠心病,男性101例,女性159例。队列人群总体发病率3.89%,发病密度13.16/千人年。冠心病发病率随BMI升高呈上升趋势(χ²_趋势=6.761,P=0.009)。中心性肥胖人群发病风险是正常人群的1.39倍(P=0.019, 95%CI:1.06-1.82),中心性肥胖合并高血压患者发生冠心病的风险是正常人群的1.77倍(P=0.001, 95%CI:1.26-2.49)。结论中心性肥胖是冠心病发病的重要危险因素。

Association of obesity,central obesity and coronary heart disease incidence in community residents: a prospective cohort study

To explore the association of obesity, central obesity and coronary heart disease incidence. Methods A perspective cohort study was conducted. By multi-stage cluster randomized sampling, 6685 community members in Pudong New Area were investigated since 2013. Demographic characteristics, exposed factors, body measurement index of respondents were collected. The median follow-up time was 3 years, and all new coronary heart disease events were registered. Student’s t test, non-parametric Kruskal-Wallis H test, chi-square test and Cox proportional hazards models were employed for statistical analysis. Results(1) During 19759.93 person-years of follow-up, 260 new patients(101 male, 159 female) were observed. The accumulative incidence rate of coronary heart disease was 3.89%, and the accumulative person-year incidence rate was 13.16 per 1000 person-years. The incidence rised with the increased BMI(χ2=6.761, P=0.009).(2) Multivariate cox analysis showed that incidence of coronary heart disease was 1.39 fold higher in residents with central obesity than the general residents(P=0.019, 95%CI: 1.06-1.82), and the risk of developing coronary heart disease was 1.77 fold higher in residents with central obesity and hypertension than residents with neither of the two risk factors(P=0.001, 95%CI: 1.26-2.49). Conclusion Central obesity is an important risk factor for coronary heart disease.