Cai Xintian, Li Nanfang, Hu Junli, Wen Wen, Yao Xiaoguang, Zhu Qing, Heizhati Mulalibieke, Hong Jing, Sun Le, Tuerxun Guzailinuer, Zhang Delian, Luo Qin
Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Xinjiang Clinical Medical Research Center for Hypertension Diseases, Urumqi, Xinjiang, People's Republic of China.
Graduate School, Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China.
J Inflamm Res. 2022 Feb 2;15:687-700. doi: 10.2147/JIR.S351238. eCollection 2022.
We aimed to investigate the relationship between the Chinese visceral adiposity index (CVAI) and the risk of new-onset myocardial infarction (MI) in patients with hypertension and obstructive sleep apnoea (OSA) and to inspect possible modifiers of the effect.
The Cox regression model was used to evaluate the relationship between baseline CVAI and risk of new-onset MI. A generalized additive model was used to identify the nonlinear relationship. Besides, we conducted subgroup analyses and interaction tests.
A total of 2177 patients with hypertension and OSA undergoing polysomnography were enrolled in this study. During a median follow-up period of 87 months, 82 participants developed new-onset MI. Overall, CVAI was positively related to the risk of new-onset MI (per 1 SD increase; HR = 1.54, 95% CI: 1.28-1.85). In multivariable-adjusted models, the risk of new-onset MI increased with quartiles of CVAI, with an HR of 3.64 (95% CI: 1.94-6.83) for quartile 4 compared with quartile 1. The generalized additive model and smoothed curve fit revealed a nonlinear relationship between CVAI and risk of new-onset MI with an inflection point of approximately 112. None of the stratification variables had a significant effect on the relationship between CVAI and new-onset MI. Similar outcomes were observed in the sensitivity analysis. The addition of CVAI significantly improved reclassification and discrimination over the conventional model, with a category-free NRI of 0.132 (95% CI 0.021 to 0.236, P = 0.021) and an IDI of 0.012 (95% CI 0.005 to 0.023, P < 0.001).
This study demonstrated a nonlinear relationship between CVAI and the risk of new-onset MI in patients with hypertension and OSA. Higher CVAI was significantly associated with the risk of new-onset MI when CVAI was ≥112.
我们旨在研究中国内脏脂肪指数（CVAI）与高血压合并阻塞性睡眠呼吸暂停（OSA）患者新发心肌梗死（MI）风险之间的关系，并探讨可能的效应修饰因素。
采用Cox回归模型评估基线CVAI与新发MI风险之间的关系。使用广义相加模型识别非线性关系。此外，我们进行了亚组分析和交互作用检验。
本研究共纳入2177例接受多导睡眠监测的高血压合并OSA患者。在中位随访期87个月期间，82例参与者发生了新发MI。总体而言，CVAI与新发MI风险呈正相关（每增加1个标准差；HR = 1.54，95%CI：1.28 - 1.85）。在多变量调整模型中，新发MI风险随CVAI四分位数增加，与第1四分位数相比，第4四分位数的HR为3.64（95%CI：1.94 - 6.83）。广义相加模型和平滑曲线拟合显示CVAI与新发MI风险之间存在非线性关系，拐点约为112。分层变量均未对CVAI与新发MI之间的关系产生显著影响。敏感性分析中观察到类似结果。与传统模型相比，加入CVAI显著改善了重新分类和鉴别能力，无类别NRI为0.132（95%CI 0.021至0.236，P = 0.021），IDI为0.012（95%CI 0.005至0.023，P < 0.001）。
本研究表明CVAI与高血压合并OSA患者新发MI风险之间存在非线性关系。当CVAI≥112时，较高的CVAI与新发MI风险显著相关。
