School of Public Health, Curtin Health Innovation Research Institute, Australian Technology Network Centre for Metabolic Fitness, Curtin University of Technology, Bentley, Western Australia, Australia.
Prev Med. 2009 Aug-Sep;49(2-3):153-7. doi: 10.1016/j.ypmed.2009.07.019. Epub 2009 Aug 4.
Our objective is to develop a parsimonious model to predict coronary heart disease (CHD) and cardiovascular disease (CVD) deaths using individual components of the Framingham risk score plus measures of central obesity.
15 year mortality follow-up of 8662 representative Australian adults in the National Heart Foundation Risk Factor Prevalence Survey of 1989, excluding those with a baseline history of heart disease, stroke or diabetes. Measures included blood pressure, fasting lipids, smoking history, body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHR). Multivariable logistic regression was used to assess the effects of the Framingham risk variables and central obesity variables on cardiovascular disease mortality.
Smoking status, high density lipoprotein cholesterol (HDL-C) and the total cholesterol (TC) to HDL-C ratio were significant univariate predictors of CHD deaths. These together with systolic blood pressure were significant predictors of CVD deaths. The obesity measures of WC and WHR were significant univariate predictors but BMI was not. In multivariable analyses, only smoking status and waist to hip ratio were identified as key independent risk factors for CHD and CVD deaths, although TC to HDL-C ratio contributed minimally to CHD deaths. Receiver operator characteristic (ROC) curves for the Framingham risk score in comparison to the WHR plus smoking model were virtually identical, with no added effect of the lipid ratio.
The preferred model for predicting CHD and CVD deaths uses central obesity plus smoking with no added influence of measured lipids or blood pressure. A public health focus on identifying and modifying central obesity is at least as important as the measurement and treatment of lipids and hypertension.
我们的目标是开发一个简约的模型，使用弗雷明汉风险评分的个体成分加上中心性肥胖的测量来预测冠心病（CHD）和心血管疾病（CVD）死亡。
对 1989 年澳大利亚国家心脏基金会风险因素流行调查中的 8662 名代表性成年人进行了 15 年的死亡率随访，排除了基线有心脏病、中风或糖尿病病史的人。测量指标包括血压、空腹血脂、吸烟史、体重指数（BMI）、腰围（WC）和腰臀比（WHR）。采用多变量逻辑回归评估弗雷明汉风险变量和中心性肥胖变量对心血管疾病死亡率的影响。
吸烟状况、高密度脂蛋白胆固醇（HDL-C）和总胆固醇（TC）与 HDL-C 比值是 CHD 死亡的显著单变量预测因子。这些因素与收缩压一起是 CVD 死亡的显著预测因子。WC 和 WHR 等肥胖指标是显著的单变量预测因子，但 BMI 不是。在多变量分析中，只有吸烟状况和腰臀比被确定为 CHD 和 CVD 死亡的关键独立危险因素，尽管 TC 与 HDL-C 比值对 CHD 死亡的贡献很小。与 WHR 加吸烟模型相比，弗雷明汉风险评分的接收者操作特征（ROC）曲线几乎相同，血脂比值没有增加影响。
预测 CHD 和 CVD 死亡的首选模型使用中心性肥胖加吸烟，测量的血脂或血压没有额外影响。公共卫生重点关注识别和改变中心性肥胖，至少与测量和治疗血脂和高血压一样重要。
