Department of Family Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea.
Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea.
Menopause. 2020 Sep;27(9):1010-1014. doi: 10.1097/GME.0000000000001581.
Many studies have reported that body composition might be associated with cardiovascular disease, but the issue has not been fully investigated in postmenopausal women.
This retrospective study comprised 582 postmenopausal women without a history of cardiovascular disease who visited the Health Promotion Center between May 2008 and February 2018. All women were screened for body fat composition by bioelectrical impedance analysis and for degree of coronary artery calcification (CAC) by multidetector computed tomography. In addition, multivariate analysis, integrated discrimination improvement, and category-free net reclassification improvement were performed.
The level of triglycerides, and the waist-hip ratio (WHR) in participants with CAC (coronary artery calcium score [CACS] > 0) were higher than in participants with a CACS of zero points. When the participants were stratified into four groups according to WHR, participants with CAC (CACS > 0) increased significantly as WHR quartile increased. A multivariate analysis showed that older age (odds ratio [OR]: 2.539; 95% confidence interval [CI]: 1.524-4.230; P < 0.001), triglyceride level (OR: 1.005; 95% CI: 1.002-1.008; P = 0.003), WHR (OR: 1.103; 95% CI: 1.018-1.195; P = 0.017), and history of hypertension (OR: 2.701; 95% CI: 1.715-4.253; P < 0.001) were significantly associated with CAC. The Brier score upon adding WHR to a clinical model was lower than that of the clinical model without WHR. Adding WHR to a clinical model better predicted CAC than a clinical model without WHR (C index: 0.761, 95% CI: 0.724-0.795, P < 0.001; net reclassification improvement: 0.195, P = 0.037; integrated discrimination improvement: 1.02%, P = 0.043).
In asymptomatic postmenopausal women, WHR as measured by bioelectrical impedance analysis was significantly associated with coronary atherosclerosis, supplementing information of usual clinical markers. Hence, WHR might be appropriate as a marker for early atherosclerosis.
许多研究报告称，体成分可能与心血管疾病有关，但这一问题在绝经后妇女中尚未得到充分研究。
本回顾性研究纳入了 582 名无心血管疾病病史的绝经后妇女，她们于 2008 年 5 月至 2018 年 2 月期间在健康促进中心接受检查。所有女性均通过生物电阻抗分析筛查体脂肪成分，并通过多排螺旋 CT 筛查冠状动脉钙化程度（CAC）。此外，还进行了多变量分析、综合判别改善和无分类净重新分类改善。
在 CAC（冠状动脉钙评分[CACS]＞0）阳性的参与者中，三酰甘油水平和腰臀比（WHR）较高，而 CACS 为 0 分的参与者则较低。当根据 WHR 将参与者分为四组时，随着 WHR 四分位的增加，CAC 阳性的参与者显著增加。多变量分析显示，年龄较大（比值比[OR]：2.539；95%置信区间[CI]：1.524-4.230；P＜0.001）、三酰甘油水平（OR：1.005；95%CI：1.002-1.008；P=0.003）、WHR（OR：1.103；95%CI：1.018-1.195；P=0.017）和高血压病史（OR：2.701；95%CI：1.715-4.253；P＜0.001）与 CAC 显著相关。将 WHR 添加到临床模型后，Brier 评分低于无 WHR 的临床模型。与无 WHR 的临床模型相比，将 WHR 添加到临床模型中可以更好地预测 CAC（C 指数：0.761，95%CI：0.724-0.795，P＜0.001；净重新分类改善：0.195，P=0.037；综合判别改善：1.02%，P=0.043）。
在无症状绝经后妇女中，生物电阻抗分析测量的 WHR 与冠状动脉粥样硬化显著相关，补充了常用临床标志物的信息。因此，WHR 可能是早期动脉粥样硬化的合适标志物。
