1 The Whitaker Cardiovascular Institute Boston University School of Medicine Boston MA.
6 Section of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.
J Am Heart Assoc. 2019 Apr 2;8(7):e010793. doi: 10.1161/JAHA.118.010793.
Background Metabolic syndrome is associated with high risk of cardiovascular disease, although risk may differ according to the specific conditions present and variability in those conditions. Methods and Results We defined obesity (body mass index [BMI] ≥30 kg/m) and metabolic health (<2 nonobesity National Cholesterol Education Program Adult Treatment Panel III conditions) among 3632 Framingham Heart Study offspring cohort participants (mean age, 50.8 years; 53.8% women) who were followed up from 1987 to 2014. We defined participants whose variance independent of the mean for a metabolic syndrome-associated measure was in the top quintile as being "variable" for that measure. Variable metabolic health was defined as ≥2 variable nonobesity metabolic syndrome components. We investigated the interaction between obesity and metabolic health in their associations with cardiometabolic disease and cardiovascular disease using Cox proportional hazards regression. In addition, we estimated the associations of BMI variability and variable metabolic health with study outcomes within categories of obesity and metabolic health status, respectively. We observed 567 incident obesity (41 439 person-years), 771 incident metabolically unhealthy state (25 765 person-years), 272 incident diabetes mellitus (56 233 person-years), 503 incident hypertension (12 957 person-years), 589 cardiovascular disease (60 300 person-years), and 195 chronic kidney disease (47 370 person-years) events on follow-up. Obesity and being metabolically unhealthy were independently and positively associated with all outcomes. BMI variability, compared with stable BMI, was associated with 163%, 67%, 58%, and 74% higher risks of having obesity, becoming metabolically unhealthy, having diabetes mellitus, and having hypertension, respectively, among nonobese participants. Variable metabolic health, compared with stable metabolic health, was associated with a 28% higher risk of cardiovascular disease, among metabolically healthy participants. Conclusions We did not observe evidence for a positive interaction between obesity and metabolic health status with regard to study outcomes. BMI and metabolic health variability are associated with adverse health outcomes.
代谢综合征与心血管疾病风险增加相关，尽管风险可能因具体情况和这些情况的变异性而异。
我们在Framingham 心脏研究后代队列参与者（平均年龄 50.8 岁，53.8%为女性）中定义了肥胖（体重指数 [BMI]≥30kg/m）和代谢健康（<2 个非肥胖国家胆固醇教育计划成人治疗小组 III 条件），这些参与者在 1987 年至 2014 年期间接受了随访。我们定义了那些与代谢综合征相关指标的方差独立于均值的参与者为该指标的“变量”。可变代谢健康定义为≥2 个可变非肥胖代谢综合征成分。我们使用 Cox 比例风险回归研究了肥胖和代谢健康之间相互作用与心血管疾病和心血管疾病的关系。此外，我们分别在肥胖和代谢健康状况的类别内，估计了 BMI 变异性和可变代谢健康与研究结果的关联。在随访期间，我们观察到 567 例肥胖事件（41439 人年）、771 例代谢不健康状态事件（25765 人年）、272 例糖尿病事件（56233 人年）、503 例高血压事件（12957 人年）、589 例心血管疾病事件（60300 人年）和 195 例慢性肾病事件（47370 人年）。肥胖和代谢不健康状态独立且正向与所有结局相关。与稳定 BMI 相比，BMI 变异性与非肥胖参与者的肥胖、代谢不健康状态、糖尿病和高血压的风险分别增加 163%、67%、58%和 74%相关。与稳定代谢健康相比，可变代谢健康与代谢健康参与者的心血管疾病风险增加 28%相关。
我们没有发现肥胖和代谢健康状况之间存在积极的相互作用与研究结果之间存在证据。BMI 和代谢健康变异性与不良健康结局相关。
