Goodman Elizabeth, Dolan Lawrence M, Morrison John A, Daniels Stephen R
Heller School for Social Policy and Management, Brandeis University, MS 35, 415 South St, Waltham, MA 02453-9110, USA.
Circulation. 2005 Apr 19;111(15):1970-7. doi: 10.1161/01.CIR.0000161957.34198.2B.
Clustering of cardiovascular (CV) risks begins in childhood, yet studies of the factor structure underlying this clustering have focused on adults. The increasing rates of obesity and type 2 diabetes and the growing importance of metabolic syndrome among adolescents make assessment of CV risk clustering even more urgent in this age group.
Exploratory factor analysis (principal components analysis) was performed with data from 1578 healthy seventh to 12th graders from the Princeton School District Study, a school-based study in Cincinnati, Ohio. Measured CV risks included cholesterol, triglycerides, fasting insulin and glucose, body mass index (BMI), waist circumference, fibrinogen, and blood pressure. Factor analysis yielded 4 uncorrelated factors (adiposity [BMI, waist, fibrinogen, insulin], cholesterol [LDL and total cholesterol], carbohydrate-metabolic [glucose, insulin, HDL cholesterol, triglycerides], and blood pressure [systolic and diastolic blood pressure]). These factors explained approximately 67% of the total variance. A summary cumulative risk scale was derived from factor scores, and high risk was defined as scoring in the top 5%. Although insulin loaded onto both the adiposity and carbohydrate-metabolic factors, obesity was a much stronger correlate of high cumulative risk (odds ratio=19.2; 95% CI, 7.6 to 48.5) than hyperinsulinemia (odds ratio=3.5; 95% CI, 1.8 to 6.8). A sizable proportion (18.5%; n=12) of those who were at high cumulative risk were not at high risk for any of the individual factors.
The patterning of CV risk clustering seen among adults is present in healthy adolescents. Among youth, obesity is the predominant correlate of cumulative risk.
心血管（CV）风险聚集始于儿童期，但对这种聚集背后因素结构的研究主要集中在成年人。肥胖和2型糖尿病发病率的上升以及代谢综合征在青少年中的重要性日益增加，使得在这个年龄组中评估CV风险聚集变得更加紧迫。
对来自俄亥俄州辛辛那提市普林斯顿学区研究的1578名健康的七年级至十二年级学生的数据进行探索性因素分析（主成分分析），该研究是一项基于学校的研究。测量的CV风险包括胆固醇、甘油三酯、空腹胰岛素和葡萄糖、体重指数（BMI）、腰围、纤维蛋白原和血压。因素分析产生了4个不相关的因素（肥胖[BMI、腰围、纤维蛋白原、胰岛素]、胆固醇[低密度脂蛋白和总胆固醇]、碳水化合物代谢[葡萄糖、胰岛素、高密度脂蛋白胆固醇、甘油三酯]和血压[收缩压和舒张压]）。这些因素解释了约67%的总方差。从因素得分得出一个汇总的累积风险量表，高风险定义为得分在前5%。尽管胰岛素同时加载到肥胖和碳水化合物代谢因素上，但肥胖与高累积风险的相关性（优势比=19.2；95%可信区间，7.6至48.5）比高胰岛素血症（优势比=3.5；95%可信区间，1.8至6.8）更强。在累积风险高的人群中，有相当一部分（18.5%；n = 12）在任何单个因素上都没有高风险。
在健康青少年中存在成年人中所见的CV风险聚集模式。在青少年中，肥胖是累积风险的主要相关因素。
