Zhang Xianglan, Shu Xiao-Ou, Gao Yu-Tang, Yang Gong, Li Honglan, Zheng Wei
Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, Tenn 37203-1738, USA.
Stroke. 2009 Apr;40(4):1098-104. doi: 10.1161/STROKEAHA.108.539692. Epub 2009 Feb 10.
Although both general and abdominal adiposity are well-established risk factors for coronary heart disease, their associations with stroke are less well characterized, particularly in generally lean Asian populations.
We evaluated associations of body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC), and waist-height ratio (WHtR) with stroke risk in the Shanghai Women's Health Study, a population-based prospective cohort study of 74 942 Chinese women aged 40 to 70 years with anthropometric measurement taken at recruitment in 1996 to 2000. For this analysis, we included 67 083 women with no prior history of stroke, coronary heart disease, rheumatic heart disease, cardiac surgery, or cancer at recruitment. Incident stroke was ascertained by biennial home visits and linkage with vital statistics registries.
Cut points for the highest quintiles of BMI, WHR, WC, and WHtR among this cohort were 26.6 (kg/m(2)), 0.85 (cm/cm), 84.1 (cm), and 0.54 (cm/cm), respectively. During a mean follow-up of 7.3 years, 2403 incident stroke cases were identified. All selected anthropometric measurements were positively and significantly associated with risk of total, ischemic, and hemorrhagic stroke in a dose-response manner (all probability values for trend <0.01). The multivariable-adjusted hazard ratios (95% confidence intervals) for total stroke comparing the highest versus lowest quintiles of these measurements were 1.71 (1.49 to 1.97), 1.59 (1.37 to 1.85), 1.77 (1.53 to 2.05), and 1.91 (1.61 to 2.27) for BMI, WHR, WC, and WHtR, respectively.
Increasing levels of general or abdominal adiposity consistently predict increased risk of stroke in predominantly nonobese Chinese women.
虽然总体肥胖和腹部肥胖都是冠心病公认的危险因素，但它们与中风的关联特征尚不明确，在普遍偏瘦的亚洲人群中尤为如此。
在上海女性健康研究中，我们评估了体重指数（BMI）、腰臀比（WHR）、腰围（WC）和腰高比（WHtR）与中风风险的关联。该研究是一项基于人群的前瞻性队列研究，纳入了74942名年龄在40至70岁的中国女性，于1996年至2000年招募时进行了人体测量。本次分析纳入了67083名在招募时无中风、冠心病、风湿性心脏病、心脏手术或癌症病史的女性。通过每两年一次的家访以及与生命统计登记处的关联来确定新发中风病例。
该队列中BMI、WHR、WC和WHtR最高五分位数的切点分别为26.6（kg/m²）、0.85（cm/cm）、84.1（cm）和0.54（cm/cm）。在平均7.3年的随访期间，共识别出2403例新发中风病例。所有选定的人体测量指标均与总中风、缺血性中风和出血性中风风险呈正相关且具有显著的剂量反应关系（所有趋势的概率值均<0.01）。这些测量指标最高与最低五分位数相比，总中风的多变量调整风险比（95%置信区间）分别为：BMI为1.71（1.49至1.97），WHR为1.59（1.37至1.85），WC为1.77（1.53至2.05），WHtR为1.91（1.61至2.27）。
在以非肥胖为主的中国女性中,总体或腹部肥胖水平的升高持续预示着中风风险的增加。
