Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
Obesity (Silver Spring). 2011 Apr;19(4):853-60. doi: 10.1038/oby.2010.168. Epub 2010 Aug 19.
It remains unclear whether abdominal obesity increases cardiovascular disease (CVD) risk independent of the metabolic abnormalities that often accompany it. Therefore, the objective of this study was to evaluate the independent effects of abdominal obesity vs. metabolic syndrome and diabetes on the risk for incident coronary heart disease (CHD) and stroke. The Framingham Offspring, Atherosclerosis Risk in Communities, and Cardiovascular Health studies were pooled to assess the independent effects of abdominal obesity (waist circumference >102 cm for men and >88 cm for women) vs. metabolic syndrome (excluding the waist circumference criterion) and diabetes on risk for incident CHD and stroke in 20,298 men and women aged ≥45 years. The average follow-up was 8.3 (s.d. 1.9) years. There were 1,766 CVD events. After adjustment for demographic factors, smoking, alcohol intake, number of metabolic syndrome components, and diabetes, abdominal obesity was not significantly associated with an increased risk of CVD (hazard ratio (HR) (95% confidence interval): 1.09 (0.98, 1.20)). However, after adjustment for demographics, smoking, alcohol intake, and abdominal obesity, having 1-2 metabolic syndrome components, the metabolic syndrome and diabetes were each associated with a significantly increased risk of CVD (2.12 (1.80, 2.50), 2.82 (1.92, 4.12), and 5.33 (3.37, 8.41), respectively). Although abdominal obesity is an important clinical tool for identification of individuals likely to possess metabolic abnormalities, these data suggest that the metabolic syndrome and diabetes are considerably more important prognostic indicators of CVD risk.
目前尚不清楚腹部肥胖是否会增加心血管疾病（CVD）的风险，而这种风险又独立于其常伴随的代谢异常。因此，本研究旨在评估腹部肥胖与代谢综合征和糖尿病对冠心病（CHD）和中风发病风险的独立影响。通过汇总 Framingham 后代、社区动脉粥样硬化风险研究和心血管健康研究的数据，评估了腹部肥胖（男性腰围>102cm，女性腰围>88cm）与代谢综合征（排除腰围标准）和糖尿病对≥45 岁 20298 名男性和女性发生 CHD 和中风的独立影响。平均随访时间为 8.3 年（标准差 1.9 年）。共发生 1766 例 CVD 事件。在调整人口统计学因素、吸烟、饮酒、代谢综合征成分数量和糖尿病后，腹部肥胖与 CVD 风险增加无关（危险比（HR）（95%置信区间）：1.09（0.98，1.20））。然而，在调整人口统计学因素、吸烟、饮酒和腹部肥胖后，存在 1-2 个代谢综合征成分、代谢综合征和糖尿病与 CVD 风险显著增加相关（2.12（1.80，2.50）、2.82（1.92，4.12）和 5.33（3.37，8.41））。尽管腹部肥胖是识别可能存在代谢异常个体的重要临床工具，但这些数据表明，代谢综合征和糖尿病是 CVD 风险更重要的预后指标。
