Division of Endocrinology University of California Los Angeles CA.
Division of Cardiology University of California Los Angeles CA.
J Am Heart Assoc. 2021 Feb;10(5):e017511. doi: 10.1161/JAHA.120.017511. Epub 2021 Feb 23.
Background To determine whether differences in body composition contribute to sex differences in cardiovascular disease (CVD) mortality, we investigated the relationship between components of body composition and CVD mortality in healthy men and women. Methods and Results Dual energy x-ray absorptiometry body composition data from the National Health and Nutrition Examination Survey 1999-2004 and CVD mortality data from the National Health and Nutrition Examination Survey 1999-2014 were evaluated in 11 463 individuals 20 years of age and older. Individuals were divided into 4 body composition groups (low muscle mass-low fat mass-the referent; low muscle-high fat; high muscle-low fat, and high muscle-high fat), and adjusted competing risks analyses were performed for CVD versus non-CVD mortality. In women, high muscle/high fat mass was associated with a significantly lower adjusted CVD mortality rate (hazard ratio [HR], 0.58; 95% CI, 0.39-0.86; =0.01), but high muscle/low fat mass was not. In men, both high muscle-high fat (HR, 0.74; 95% CI, 0.53-1.04; =0.08) and high muscle-low fat mass (HR, 0.40; 95% CI, 0.21-0.77; =0.01) were associated with lower CVD. Further, in adjusted competing risks analyses stratified by sex, the CVD rate in women tends to significantly decrease as normalized total fat increase (total fat fourth quartile: HR, 0.56; 95% CI, 0.34-0.94; <0.03), whereas this is not noted in men. Conclusions Higher muscle mass is associated with lower CVD and mortality in men and women. However, in women, high fat, regardless of muscle mass level, appears to be associated with lower CVD mortality risk. This finding highlights the importance of muscle mass in healthy men and women for CVD risk prevention, while suggesting sexual dimorphism with respect to the CVD risk associated with fat mass.
为了确定身体成分的差异是否导致心血管疾病（CVD）死亡率的性别差异，我们研究了健康男性和女性身体成分各组成部分与 CVD 死亡率之间的关系。
使用 1999-2004 年全国健康和营养调查（NHANES）的双能 X 射线吸收法（DXA）身体成分数据和 1999-2014 年全国健康和营养调查的 CVD 死亡率数据，对 11463 名年龄在 20 岁及以上的个体进行了评估。将个体分为 4 个体脂组成组（低肌肉量-低脂肪量-参照；低肌肉量-高脂肪量；高肌肉量-低脂肪量和高肌肉量-高脂肪量），并对 CVD 与非 CVD 死亡率进行了调整后的竞争风险分析。在女性中，高肌肉/高脂肪量与较低的调整后 CVD 死亡率显著相关（风险比[HR]，0.58；95%置信区间，0.39-0.86；=0.01），而高肌肉/低脂肪量则没有。在男性中，高肌肉/高脂肪量（HR，0.74；95%置信区间，0.53-1.04；=0.08）和高肌肉/低脂肪量（HR，0.40；95%置信区间，0.21-0.77；=0.01）都与较低的 CVD 相关。此外，在按性别分层的调整后的竞争风险分析中，女性的 CVD 发生率随着总脂肪量的增加而显著下降（第四四分位的总脂肪量：HR，0.56；95%置信区间，0.34-0.94；<0.03），而男性则没有。
较高的肌肉量与男性和女性的较低 CVD 和死亡率相关。然而，在女性中，无论肌肉量水平如何，高脂肪似乎与较低的 CVD 死亡率风险相关。这一发现强调了肌肉量在预防 CVD 风险方面对健康男性和女性的重要性，同时表明了脂肪量与 CVD 风险相关的性别差异。
