Yusuf Salim, Hawken Steven, Ounpuu Stephanie, Bautista Leonelo, Franzosi Maria Grazia, Commerford Patrick, Lang Chim C, Rumboldt Zvonko, Onen Churchill L, Lisheng Liu, Tanomsup Supachai, Wangai Paul, Razak Fahad, Sharma Arya M, Anand Sonia S
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
Lancet. 2005 Nov 5;366(9497):1640-9. doi: 10.1016/S0140-6736(05)67663-5.
Obesity is a major risk factor for cardiovascular disease, but the most predictive measure for different ethnic populations is not clear. We aimed to assess whether markers of obesity, especially waist-to-hip ratio, would be stronger indicators of myocardial infarction than body-mass index (BMI), the conventional measure.
We did a standardised case-control study of acute myocardial infarction with 27 098 participants in 52 countries (12,461 cases and 14,637 controls) representing several major ethnic groups. We assessed the relation between BMI, waist and hip circumferences, and waist-to-hip ratio to myocardial infarction overall and for each group.
BMI showed a modest and graded association with myocardial infarction (OR 1.44, 95% CI 1.32-1.57 top quintile vs bottom quintile before adjustment), which was substantially reduced after adjustment for waist-to-hip ratio (1.12, 1.03-1.22), and non-significant after adjustment for other risk factors (0.98, 0.88-1.09). For waist-to-hip ratio, the odds ratios for every successive quintile were significantly greater than that of the previous one (2nd quintile: 1.15, 1.05-1.26; 3rd quintile: 1.39; 1.28-1.52; 4th quintile: 1.90, 1.74-2.07; and 5th quintiles: 2.52, 2.31-2.74 [adjusted for age, sex, region, and smoking]). Waist (adjusted OR 1.77; 1.59-1.97) and hip (0.73; 0.66-0.80) circumferences were both highly significant after adjustment for BMI (p<0.0001 top vs bottom quintiles). Waist-to-hip ratio and waist and hip circumferences were closely (p<0.0001) associated with risk of myocardial infarction even after adjustment for other risk factors (ORs for top quintile vs lowest quintiles were 1.75, 1.33, and 0.76, respectively). The population-attributable risks of myocardial infarction for increased waist-to-hip ratio in the top two quintiles was 24.3% (95% CI 22.5-26.2) compared with only 7.7% (6.0-10.0) for the top two quintiles of BMI.
Waist-to-hip ratio shows a graded and highly significant association with myocardial infarction risk worldwide. Redefinition of obesity based on waist-to-hip ratio instead of BMI increases the estimate of myocardial infarction attributable to obesity in most ethnic groups.
肥胖是心血管疾病的主要危险因素，但对于不同种族人群而言，最具预测性的指标尚不清楚。我们旨在评估肥胖指标，尤其是腰臀比，相较于传统指标体重指数（BMI），是否为心肌梗死更强的预测指标。
我们在52个国家对27098名参与者开展了一项标准化的急性心肌梗死病例对照研究（12461例病例和14637名对照），这些参与者代表了几个主要种族群体。我们评估了BMI、腰围和臀围以及腰臀比与总体心肌梗死及每组心肌梗死之间的关系。
BMI与心肌梗死呈适度的分级关联（调整前，最高五分位数与最低五分位数相比，比值比为1.44，95%置信区间为1.32 - 1.57），在调整腰臀比后大幅降低（1.12，1.03 - 1.22），在调整其他危险因素后无统计学意义（0.98，0.88 - 1.09）。对于腰臀比，每连续一个五分位数的比值比均显著高于前一个（第二个五分位数：1.15，1.05 - 1.26；第三个五分位数：1.39，1.28 - 1.52；第四个五分位数：1.90，1.74 - 2.07；第五个五分位数：2.52，2.31 - 2.74 [调整年龄、性别、地区和吸烟因素后]）。在调整BMI后，腰围（调整后的比值比为1.77；1.59 - 1.97）和臀围（0.73；0.66 - 0.80）均具有高度统计学意义（最高与最低五分位数相比，p<0.0001）。即使在调整其他危险因素后，腰臀比以及腰围和臀围与心肌梗死风险仍密切相关（最高五分位数与最低五分位数的比值比分别为1.75、1.33和0.76）。与BMI最高的两个五分位数仅7.7%（6.0 - 10.0）相比，腰臀比最高的两个五分位数导致心肌梗死的人群归因风险为24.3%（95%置信区间为22.5 - 26.2）。
腰臀比在全球范围内与心肌梗死风险呈分级且高度显著的关联。基于腰臀比而非BMI重新定义肥胖，可提高大多数种族群体中归因于肥胖的心肌梗死估计值。
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