Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.
Osaka Center for Cancer and Cardiovascular Disease Prevention.
J Atheroscler Thromb. 2022 Mar 1;29(3):422-437. doi: 10.5551/jat.60103. Epub 2021 Mar 16.
We aimed to examine the impact of high-risk levels of cardiovascular risk factors on the incidence of cardiovascular disease (CVD) in overweight and non-overweight individuals without treatment for the risk factors.
A total of 8,051 individuals aged 40-74 years without a history of CVD and/or without treatment for hypertension, diabetes, hyperlipidemia, and kidney disease at baseline in 1995-2000 were followed up for a median of 14.1 years. We classified the participants into three risk categories (low-, intermediate-, and high-risk groups) on the basis of individual risk factors (blood pressure, serum glucose, low-density lipoprotein cholesterol [LDL-C], and urinary protein) according to the guidelines of Japanese clinical societies. The high-risk group (systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 100 mmHg, fasting serum glucose ≥ 130 mg/dL or non-fasting serum glucose ≥ 180 mg/dL, LDL-C ≥ 180 mg/dL, proteinuria ≥ 2+) needed to refer to physicians or start treatment immediately. Overweight was defined as a body mass index of ≥ 25 kg/m.
Compared with those in the non-overweight low-risk group, the hazard ratios (HRs) (95% confidence intervals, population-attributable fractions [PAFs]) of CVD in the high-risk categories of blood pressure were 2.0 (1.4-2.9, 7.0%) in the non-overweight high-risk group and 2.9 (1.9-4.3, 6.8%) in the overweight high-risk group. The corresponding HRs (95% confidence intervals, PAFs) of serum glucose were 2.0 (1.2-3.4, 2.5%) and 2.2 (1.1-4.3, 1.5%) in the non-overweight and overweight high-risk groups, respectively. Such associations were not observed for the high-risk group of LDL-C and proteinuria.
The present long-term observational study implies that targeting persons with non-treated severe hypertension and diabetes is prioritized to prevent CVD regardless of overweight status.
本研究旨在探讨在未针对心血管危险因素进行治疗的超重和非超重人群中，高水平心血管危险因素对心血管疾病（CVD）发病率的影响。
1995-2000 年，共有 8051 名年龄在 40-74 岁之间、无 CVD 病史且基线时无高血压、糖尿病、血脂异常和肾脏疾病治疗史的个体纳入研究并进行随访，中位随访时间为 14.1 年。我们根据日本临床学会指南，根据个体危险因素（血压、血清葡萄糖、低密度脂蛋白胆固醇[LDL-C]和尿蛋白）将参与者分为三个风险类别（低危组、中危组和高危组）。高危组（收缩压≥160mmHg 或舒张压≥100mmHg、空腹血清葡萄糖≥130mg/dL 或非空腹血清葡萄糖≥180mg/dL、LDL-C≥180mg/dL、蛋白尿≥2+）需要立即就诊或开始治疗。超重定义为 BMI≥25kg/m。
与非超重低危组相比，非超重高危组中血压高危组的 CVD 风险比（HR）（95%置信区间，人群归因分数[PAF]）为 2.0（1.4-2.9，7.0%），超重高危组的 HR 为 2.9（1.9-4.3，6.8%）。血清葡萄糖高危组的 HR（95%置信区间，PAF）在非超重和超重高危组中分别为 2.0（1.2-3.4，2.5%）和 2.2（1.1-4.3，1.5%）。LDL-C 和蛋白尿高危组未观察到这种相关性。
本长期观察性研究表明，无论超重与否，针对未经治疗的严重高血压和糖尿病患者进行靶向治疗是预防 CVD 的首要任务。
