Kannel W B, Cupples L A, Ramaswami R, Stokes J, Kreger B E, Higgins M
Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, MA 02118.
J Clin Epidemiol. 1991;44(2):183-90. doi: 10.1016/0895-4356(91)90265-b.
Risk of cardiovascular events was determined over 24 years of surveillance in relation to general adiposity reflected by relative weight and by regional obesity estimated by skinfolds and waist girth per inch of height. Upper quintile values of relative weight, subscapular skinfolds and waist girth were each associated with increased risks of cardiovascular disease in both sexes. Risk of total cardiovascular events increased with the degree of regional, central or abdominal obesity. Mortality from cardiovascular disease was also increased. Increased relative weight and central obesity were both associated with increased risk factors including cholesterol, blood pressure, glucose and uric acid. Changes in weight were mirrored by changes in risk factors with linear trends over a 15 lb range of weight fluctuations. Subscapular skinfold and the ratio of subscapular-to-triceps skinfold, measures of central obesity, were in either sex also associated with an increased probability of coronary attacks in particular. The subscapular skinfold contributed to CHD risk independent of body mass index (BMI). Multivariate analyses taking all the risk factors into account indicate an independent effect of abdominal obesity on stroke, cardiac failure and cardiovascular and all-cause mortality in men. In women, only the subscapular-to-triceps skinfold ratio independently contributes to CHD, cardiovascular and all cause mortality. Regional obesity appears to be an independent contributor to cardiovascular disease at a given level of general adiposity, its effect only partially mediated through promotion of other known risk factors. These data suggest that cardiovascular disease is as closely linked to abdominal as to general adiposity.
在24年的监测中，根据相对体重反映的总体肥胖情况以及通过皮褶厚度和每身高英寸腰围估算的局部肥胖情况，确定心血管事件的风险。相对体重、肩胛下皮褶厚度和腰围的上五分位数在男女中均与心血管疾病风险增加相关。总体心血管事件的风险随着局部、中心或腹部肥胖程度的增加而增加。心血管疾病死亡率也有所上升。相对体重增加和中心性肥胖均与包括胆固醇、血压、血糖和尿酸在内的风险因素增加有关。在15磅体重波动范围内，风险因素的变化与体重变化呈线性趋势。肩胛下皮褶厚度以及肩胛下与肱三头肌皮褶厚度之比（中心性肥胖的指标）在男女中也尤其与冠状动脉发作的可能性增加有关。肩胛下皮褶厚度独立于体重指数（BMI）对冠心病风险有影响。考虑所有风险因素的多变量分析表明，腹部肥胖对男性中风、心力衰竭以及心血管疾病和全因死亡率有独立影响。在女性中，只有肩胛下与肱三头肌皮褶厚度之比独立地影响冠心病、心血管疾病和全因死亡率。在总体肥胖的给定水平下，局部肥胖似乎是心血管疾病的一个独立影响因素，其作用仅部分通过促进其他已知风险因素来介导。这些数据表明，心血管疾病与腹部肥胖和总体肥胖的关联程度相当。
