Hirakawa Yoichiro, Lam Tai-Hing, Welborn Timothy, Kim Hyeon Chang, Ho Suzanne, Fang Xianghua, Ueshima Hirotsugu, Suh Il, Giles Graham, Woodward Mark
The George Institute for Global Health, University of Sydney, Australia.
School of Public Health, The University of Hong Kong, Hong Kong, China.
Prev Med Rep. 2015 Dec 30;3:79-82. doi: 10.1016/j.pmedr.2015.12.012. eCollection 2016 Jun.
To assess whether body mass index (BMI) modifies the associations of lipids with coronary heart disease (CHD).
In the Asia Pacific Cohort Studies Collaboration, total cholesterol (TC), high density lipoprotein cholesterol (HDLC) and triglycerides (TG) were measured for 333,297, 71,777 and 84,015 participants, respectively. All participants had measured BMI, categorized into underweight, normal, high-normal, overweight and obese, using standard definitions. For each BMI subgroup the effects of lipids on CHD were estimated per 1 standard deviation (SD) increase using Cox proportional hazard models, stratified by study and sex, adjusted for age and smoking. They were compared across the BMI groups, testing for interactions.
In the analyses for TC, HDLC and TG, there were 3121, 714 and 808 CHD events during a mean follow-up of 6.7 years. The risk of CHD increased monotonically with increasing TC and decreasing HDLC in all BMI subgroups without evidence of heterogeneity (p for interaction > 0.4). In contrast, the hazard ratio for CHD for a one SD increase in log-transformed TG increased from 1.07 (95%CI 0.72-1.59) in underweight, 1.26 (1.10-1.44) in normal weight, 1.27 (1.08-1.49) in high-normal weight, 1.37 (1.22-1.55) in overweight, to 1.61(1.30-1.99) in obesity (p = 0.01 for interaction trend). These associations were attenuated (p = 0.07 for interaction) but remained significant in the overweight and obese after further adjustment for TC and HDLC.
Greater excess body weight exacerbated the effects of TG, but not TC or HDLC, on CHD, suggesting that additional effort is required to reduce TG in the overweight and obese.
评估体重指数（BMI）是否会改变脂质与冠心病（CHD）之间的关联。
在亚太队列研究协作组中，分别对333297名、71777名和84015名参与者测量了总胆固醇（TC）、高密度脂蛋白胆固醇（HDLC）和甘油三酯（TG）。所有参与者均测量了BMI，并根据标准定义分为体重过轻、正常、高正常、超重和肥胖。对于每个BMI亚组，使用Cox比例风险模型，按研究和性别分层，调整年龄和吸烟因素，估计每增加1个标准差（SD）的脂质对冠心病的影响。对各BMI组进行比较，并检验交互作用。
在对TC、HDLC和TG的分析中，在平均6.7年的随访期间，分别有3121例、714例和808例冠心病事件。在所有BMI亚组中，冠心病风险随TC升高和HDLC降低而单调增加，无异质性证据（交互作用p>0.4）。相比之下，对数转换后的TG每增加1个SD，冠心病的风险比从体重过轻组的1.07（95%CI 0.72-1.59）、正常体重组的1.26（1.10-1.44）、高正常体重组的1.27（1.08-1.49）、超重组的1.37（1.22-1.55）增加到肥胖组的1.61（1.30-1.99）（交互作用趋势p=0.01）。在进一步调整TC和HDLC后，这些关联减弱（交互作用p=0.07），但在超重和肥胖组中仍具有显著性。
更多的超重会加剧TG而非TC或HDLC对冠心病的影响，这表明需要付出额外努力来降低超重和肥胖人群的TG水平。
