脂堆积产物与肥胖指标预测心血管疾病和全因死亡率的性能比较：德黑兰血脂和血糖研究，8.6 年随访结果。
Predictive performances of lipid accumulation product vs. adiposity measures for cardiovascular diseases and all-cause mortality, 8.6-year follow-up: Tehran lipid and glucose study.
机构信息
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University, Tehran, Iran.
出版信息
Lipids Health Dis. 2010 Sep 16;9:100. doi: 10.1186/1476-511X-9-100.
BACKGROUND
The body mass index (BMI) is the most commonly used marker for evaluating obesity related risks, however, central obesity measures have been proposed to be more informative. Lipid accumulation product (LAP) is an alternative continuous index of lipid accumulation. We sought in this study to assess if LAP can outperform BMI, waist-to-height-ratio (WHtR), or waist-to-hip-ratio (WHpR) in predicting incident cardiovascular disease (CVD) or all-cause mortality.
RESULTS
Among participants of Tehran Lipid and Glucose Study, 6,751 participants (2,964 men), aged ≥ 30 years, were followed for a median of 8.6 years. We observed 274 deaths (men: 168) and 447 CVD events (men: 257). Levels of common CVD risk factors significantly increased across LAP quartiles. Mortality rates did not differ by LAP quartiles. Among participants free of CVD at baseline [6331 (2,741 men)], CVD incident rates per 1000 person increased in a stepwise fashion with increasing LAP quartile values in both men (from 6.9 to 17.0) and women (from 1.3 to 13.0), (Ps < 0.001). Among women, a 1-SD increment in log-LAP conferred a 41% increased risk for CVD (HR 1.41, 95% CIs 1.02-1.96). Among men, however, LAP was not observed to be independently associated with increased risk of CVD; except in a sub-group of men assigned to the lifestyle modification interventions, where, LAP predicted CVD risk. After adjustment with CVD risk factors LAP turned to be inversely associated with risk of all-cause mortality (HR, men 0.74, 95% CIs 0.61-0.90; women, 0.94 95% CIs 0.74-1.20). Among women, magnitude of increased risk of CVD due to LAP was not different from those of anthropometric measures. Among men, however, WHpR was observed to be more strongly associated with increased risk of CVD than was LAP. Among neither men nor women were the predictive performances (discrimination, calibration, goodness-of-fit) of the LAP better than those of different anthropometric measures were.
CONCLUSIONS
If LAP is to be used for predicting CVD, it might not be superior to WHtR or WHpR.
背景
体重指数（BMI）是评估肥胖相关风险最常用的指标，但也有人提出中心性肥胖指标更具信息量。脂积产物（LAP）是衡量脂类蓄积的替代连续指标。本研究旨在评估 LAP 是否比 BMI、腰围身高比（WHtR）或腰围臀围比（WHpR）在预测心血管疾病（CVD）或全因死亡率方面更具优势。
结果
在德黑兰血脂和血糖研究中，对 6751 名年龄≥30 岁的参与者进行了随访，中位随访时间为 8.6 年。我们观察到 274 例死亡（男性：168 例）和 447 例 CVD 事件（男性：257 例）。随着 LAP 四分位数的升高，常见 CVD 危险因素的水平显著升高。死亡率不因 LAP 四分位数而有所不同。在基线时无 CVD 的参与者中[6331 名（男性 2741 名）]，男性（从 6.9 例/1000 人增至 17.0 例/1000 人）和女性（从 1.3 例/1000 人增至 13.0 例/1000 人）中，LAP 四分位数值呈递增趋势，CVD 发生率逐渐升高，差异具有统计学意义（P<0.001）。在女性中，log-LAP 增加 1 个标准差，CVD 风险增加 41%（HR 1.41，95%CI 1.02-1.96）。然而，在男性中，LAP 与 CVD 风险增加无关；除了被分配到生活方式改变干预的男性亚组外，LAP 预测 CVD 风险。在调整 CVD 危险因素后，LAP 与全因死亡率呈负相关（HR，男性 0.74，95%CI 0.61-0.90；女性，0.94，95%CI 0.74-1.20）。在女性中，由于 LAP 而导致 CVD 风险增加的幅度与人体测量指标相似。然而，在男性中，WHpR 与 CVD 风险增加的相关性强于 LAP。在男性和女性中，LAP 的预测性能（区分度、校准度、拟合优度）均不如不同的人体测量指标。
结论
如果要使用 LAP 预测 CVD，其效果可能不如 WHtR 或 WHpR。
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