Department of Biomedical Sciences Seoul National University Graduate School Seoul South Korea.
Pyeongchang Health Center and County Hospital Pyeongchang South Korea.
J Am Heart Assoc. 2019 Sep 17;8(18):e013471. doi: 10.1161/JAHA.119.013471. Epub 2019 Sep 4.
Background Body mass index and waist circumference (WC) are commonly used metrics that reflect general obesity and abdominal obesity. However, the impact of general and abdominal obesity discrepancies on the risk for major adverse cardiac events (MACE) is less explored. Methods and Results The study population was derived from the Korean National Health Insurance Service-Health Screening Cohort. Among 315 982 participants aged 40 years or older who underwent health examinations between 2008 and 2009, body mass index and WC were used to determine the obesity status. The participants were followed from January 1, 2010 for MACE until December 31, 2015. Cox proportional hazards models were used to evaluate the association of obesity and the risk of MACE. Compared with men who were not obese, those with abdominal obesity without general obesity (adjusted hazard ratio (aHR) 1.29, 95% CI 1.16-1.43), and general and abdominal obesity (aHR 1.20, 95% CI 1.12-1.29) had elevated risk of MACE, while those with general obesity without abdominal obesity (aHR 1.06, 95% CI 0.98-1.16) did not. Similarly, women with abdominal obesity without general obesity (aHR 1.13, 95% CI 1.03-1.24) and those with general and abdominal obesity (aHR 1.15, 95% CI 1.06-1.25) had increased risk of MACE, while those with general obesity without abdominal obesity (aHR 1.07, 95% CI 0.88-1.30) did not. Conclusions Abdominal obesity without general obesity was associated with an elevated risk of major cardiovascular outcomes while general obesity without abdominal obesity did not. Concurrent determination of body mass index and WC may be beneficial for the accurate determination of future cardiovascular risk.
背景 体重指数和腰围（WC）是常用的反映总体肥胖和腹部肥胖的指标。然而，总体肥胖和腹部肥胖差异对主要不良心脏事件（MACE）风险的影响研究较少。
方法和结果 研究人群来自韩国国家健康保险服务-健康筛查队列。在 2008 年至 2009 年期间接受健康检查的 315982 名年龄在 40 岁或以上的参与者中，使用体重指数和 WC 来确定肥胖状况。从 2010 年 1 月 1 日开始对参与者进行 MACE 随访，直至 2015 年 12 月 31 日。使用 Cox 比例风险模型评估肥胖与 MACE 风险的关系。与非肥胖男性相比，腹部肥胖而无总体肥胖的男性（调整后的危险比[aHR]1.29，95%置信区间[CI]1.16-1.43）和总体肥胖与腹部肥胖的男性（aHR 1.20，95%CI 1.12-1.29）MACE 风险增加，而无腹部肥胖的单纯性肥胖男性（aHR 1.06，95%CI 0.98-1.16）则无此风险。同样，女性中腹部肥胖而无总体肥胖（aHR 1.13，95%CI 1.03-1.24）和总体肥胖与腹部肥胖的女性（aHR 1.15，95%CI 1.06-1.25）MACE 风险增加，而无腹部肥胖的单纯性肥胖女性（aHR 1.07，95%CI 0.88-1.30）则无此风险。
结论 无总体肥胖的腹部肥胖与主要心血管结局风险增加相关，而无腹部肥胖的单纯性肥胖则无此相关性。同时确定体重指数和 WC 可能有助于更准确地确定未来的心血管风险。
