Murthy Venkatesh L, Abbasi Siddique A, Siddique Juned, Colangelo Laura A, Reis Jared, Venkatesh Bharath A, Carr J Jeffrey, Terry James G, Camhi Sarah M, Jerosch-Herold Michael, de Ferranti Sarah, Das Saumya, Freedman Jane, Carnethon Mercedes R, Lewis Cora E, Lima Joao A C, Shah Ravi V
Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, MI Nuclear Medicine Division, Department of Radiology, University of Michigan, Ann Arbor, MI
Providence VA Medical Center and Cardiovascular Institute, Alpert Medical School of Brown University, Providence, RI.
J Am Heart Assoc. 2016 Oct 13;5(10):e003934. doi: 10.1161/JAHA.116.003934.
Despite evidence suggesting that early metabolic dysfunction impacts cardiovascular disease risk, current guidelines focus on risk assessments later in life, missing early transitions in metabolic risk that may represent opportunities for averting the development of cardiovascular disease.
In 4420 young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we defined a "metabolic" risk score based on components of the Third Report of the Adult Treatment Panel's definition of metabolic syndrome. Using latent class trajectory analysis adjusted for sex, race, and time-dependent body mass index, we identified 6 distinct metabolic trajectories over time, specified by initial and final risk: low-stable, low-worsening, high-stable, intermediate-worsening, intermediate-stable, and high-worsening. Overall, individuals gained weight over time in CARDIA with statistically but not clinically different body mass index trend over time. Dysglycemia and dyslipidemia over time were highest in initially high or worsening trajectory groups. Divergence in metabolic trajectories occurred in early adulthood (before age 40), with 2 of 3 individuals experiencing an increase in metabolic risk over time. Membership in a higher-risk trajectory (defined as initially high or worsening over time) was associated with greater prevalence and extent of coronary artery calcification, left ventricular mass, and decreased left ventricular strain at year 25. Importantly, despite similar rise in body mass index across trajectories over 25 years, coronary artery calcification and left ventricular structure and function more closely tracked risk factor trajectories.
Transitions in metabolic risk occur early in life. Obesity-related metabolic dysfunction is related to subclinical cardiovascular phenotypes independent of evolution in body mass index, including coronary artery calcification and myocardial hypertrophy and dysfunction.
尽管有证据表明早期代谢功能障碍会影响心血管疾病风险，但当前指南侧重于生命后期的风险评估，忽略了代谢风险的早期转变，而这些转变可能是避免心血管疾病发展的机会。
在青年动脉粥样硬化风险发展研究（CARDIA）中的4420名年轻成年人中，我们基于成人治疗小组第三次报告中代谢综合征的定义组成部分定义了一个“代谢”风险评分。使用针对性别、种族和随时间变化的体重指数进行调整的潜在类别轨迹分析，我们确定了随时间变化的6种不同的代谢轨迹，由初始和最终风险指定：低稳定、低恶化、高稳定、中度恶化、中度稳定和高恶化。总体而言，CARDIA研究中的个体随时间体重增加，体重指数随时间的变化在统计学上有差异，但在临床上无差异。随着时间的推移，血糖异常和血脂异常在最初处于高风险或风险恶化轨迹组中最高。代谢轨迹的差异在成年早期（40岁之前）出现，三分之二的个体随着时间的推移代谢风险增加。处于较高风险轨迹（定义为最初高风险或随时间恶化）与25岁时冠状动脉钙化的患病率和程度更高、左心室质量增加以及左心室应变降低有关。重要的是，尽管在25年中各轨迹的体重指数上升相似，但冠状动脉钙化以及左心室结构和功能更紧密地跟踪了风险因素轨迹。
代谢风险的转变在生命早期就会发生。与肥胖相关的代谢功能障碍与亚临床心血管表型有关，独立于体重指数的变化，包括冠状动脉钙化、心肌肥大和功能障碍。
