Saito Isao, Yamauchi Kanako, Yamaizumi Masamitsu, Kato Tadahiro
Department of Public Health and Epidemiology, Faculty of Medicine, Oita University.
Faculty of Education, Fukuyama City University.
Nihon Koshu Eisei Zasshi. 2022 May 24;69(5):394-402. doi: 10.11236/jph.21-132. Epub 2022 Mar 16.
Objective To investigate the relationship between metabolic syndrome (MetS) and stroke incidence in a rural population by a prospective cohort study over 18.6 years.Methods From 1996 to 1998, 4,068 subjects (aged 40-74 years) underwent a health checkup in O city, Ehime Prefecture, Japan, and 3,969 subjects were included, excluding those with a history of stroke, to determine whether they had suffered a stroke or died from stroke by the end of December 2018. The subjects were stratified into six groups on the presence of high waist circumference at baseline and the number of risk factors (0, 1, or 2 or more) for high blood pressure, dyslipidemia, and high blood glucose, according to the diagnostic criteria for MetS in Japan. Kaplan-Meier analysis of MetS survival curves and Cox proportional hazards models were used to calculate sex- and age-adjusted hazard ratios and population attributable fractions (PAFs) for total stroke, hemorrhagic stroke, and cerebral infarction.Results During the follow-up period, 376 patients were identified as having had a stroke; the percentage of MetS in the stroke group was 15.2% compared to 9.4% in the non-stroke group, a significant difference. The sex- and age-adjusted hazard ratios for total stroke and cerebral infarction were approximately 2-fold higher in the groups with 1 risk and 2 or more risks, regardless of waist circumference, than in the group with normal waist circumference and no risks. PAF to total stroke incidence was highest in the group with normal waist circumference and 1 risk factor (18.9%).Conclusions The contribution of MetS to stroke incidence was not significant. Consistent with previous findings, the risk of stroke was increased in non-obese individuals who had at least one risk factor, such as high blood pressure.
目的 通过一项为期18.6年的前瞻性队列研究，探讨农村人群中代谢综合征（MetS）与卒中发病率之间的关系。方法 1996年至1998年，日本爱媛县O市4068名年龄在40 - 74岁的受试者接受了健康检查，排除有卒中病史的受试者后，纳入3969名受试者，以确定他们在2018年12月底前是否发生过卒中或死于卒中。根据日本MetS诊断标准，根据基线时高腰围的存在情况以及高血压、血脂异常和高血糖的危险因素数量（0、1或2个及以上），将受试者分为六组。采用MetS生存曲线的Kaplan-Meier分析和Cox比例风险模型，计算总卒中、出血性卒中和脑梗死的性别和年龄调整风险比及人群归因分数（PAF）。结果 随访期间，376例患者被确定发生过卒中；卒中组MetS的比例为15.2%，非卒中组为9.4%，差异有统计学意义。无论腰围如何，有1个危险因素组和2个及以上危险因素组的总卒中和脑梗死的性别和年龄调整风险比，比腰围正常且无危险因素组高约2倍。总卒中发病率的PAF在腰围正常且有1个危险因素组中最高（18.9%）。结论 MetS对卒中发病率的贡献不显著。与先前研究结果一致，至少有一个危险因素（如高血压）的非肥胖个体卒中风险增加。
