代谢综合征与心血管疾病的关系及其组分间的交互作用

目的 探讨代谢综合征(MS)与心血管疾病(CVD)的关系及其组分问的交互作用.方法 采用队列研究的方法,以江苏省多代谢异常和MS综合防治研究(35～74岁)中随访时间满5年的人群为研究对象,共3598例,其中男性1451例.采用2005年美国胆固醇教育计划成人教育组Ⅲ(ATPm)亚洲人群修订标准诊断MS;运用COX比例风险模型分析MS及其组分与CVD的关系;以logistic回归模型中纳入乘积项的方法来评价MS组分之间的相乘交互作用,计算相加交互作用指标相对超危险度比(RERI),归因比(AP)和交互作用指数(S)的点估计值及其95%CI以评价MS组分之间的相加交互作用.结果 调整CVD一般危险因素后,基线MS患者与非MS患者相比发生CVD的调整相对危险度(αRR)为2.49(95%(CI:1.59～3.90).MS各组分与CVD的αRR分别为:腰围1.44(95%CI:0.88～2.37),血压2.84(95%CI:1.73～4.68),低高密度脂蛋白胆固醇1.31(95%CI:0.83～2.07),甘油三酯1.84(95%CI:1.19～2.85),空腹血糖1.55(95%CI:0.98～2.45);进一步进行组分间互相调整后,发现仅血压仍与CVD有联系αRR=2.58(1.55～4.29)].交互作用分析结果显示:当血压合并2、3或4项MS其余组分时,发生CVD的危险明显增加αOR=4.47(2.35～8.51)];logistic回归模型中乘积项血压×合并2、3、4项MS其余组分无统计学意义(P>0.05);相加交互作用指标RER/和AP的95%CI包含O,S的95%CI包含1.结论 MS组分中仅血压是CVD的独立危险因素,当血压合并其他MS组分时,MS患者发生CVD事件的风险明显增加,但MS不独立于血压和MS其余组分增加CVD的风险,血压与其他MS组分对CVD未发现明显的增效作用.

Association and interaction between the components of metabolic syndrome and cardiovascular disease

Objective To explore the association and interaction between the components of metabolic syndrome (MS) and cardiovascular disease (CVD).Method In this cohort study,participants (total 3598,male 1451) were recruited and followed up for five years from the program "prevention of multiple metabolic disorders and MS in Jiangsu province".We used modified Asian criteria of the National Cholesterol Education Program Adult Treatment Panel Ⅲ (NCEP ATP Ⅲ) to define the presence of MS.COX regression was used to analyze the association between the MS and its components with CVD; both the multiplication of blood pressure (BP) and 2,3 ,or 4 other components of MS in the logistic regression model and the estimation of the relative excess risk due to interaction (RERI),the attributable proportion due to interaction (AP),and the synergy index (S) and 95% confidence intervals (95%CI) were used to evaluate the interactions between the components of MS.Results After adjustment for traditional CVD risks,the adjusted risk ratio (αRR) of CVD was 2.49 (95% CI: 1.59-3.90) in the MS group compared with the non-MS group at baseline.The αRRs of MS components to CVD were as follows: 1.44 (95% C1:0.88-2.37) for waist circumfcrence; 2.84 (95% CI:1.73-4.68) for BP; 1.31 (95 % CI:0.83-2.07) for low high density lipoprotein; 1.84 (95 % CI: 1.19-2.85) for triglyceride; 1.55 (95 % CI: 0.98 -2.45) for fasting plasma glucose,respectively.BP was the single component significantly related to CVD (αRR =2.58,95% CI: 1.55 -4.29).The risk of CVD was significantly increased (αOR = 4.47,95 % CI: 2.35 -8.51) when BP was combined with 2,3 or 4 other components of MS in the participants.Conclusions Only BP is an independent CVD risk factor in the components of MS,the risk of CVD was significantly increased when BP was combined with other components of MS in this cohort.