Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, 830017, China.
Department of Clinical Nursing, School of Nursing, Xinjiang Medical University, Urumqi, 830017, China.
Cardiovasc Diabetol. 2022 Nov 1;21(1):225. doi: 10.1186/s12933-022-01670-x.
Waist circumference (WC), visceral adiposity index (VAI), lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) are considered surrogate indicators of abdominal fat deposition, but the longitudinal association of these indices with cardiovascular (CV) events in adults with type 2 diabetes (T2D) remains unclear. Our study aimed to examine the associations between abdominal obesity indices and incident CV events among people with T2D and to compare their predictive performance in risk assessment.
The present study included 2328 individuals with T2D from the Xinjiang Multi-Ethnic Cohort. Multivariable Cox regression analyses were applied to assess the associations between abdominal obesity indices and CV events. Harrell's concordance statistic (C-statistic), net reclassification improvement (NRI) index, and integrated discrimination improvement (IDI) index were utilized to evaluate the predictive performance of each abdominal obesity index.
At a median follow-up period of 59 months, 289 participants experienced CV events. After multivariable adjustment, each 1-SD increase in WC, VAI, LAP, and CVAI was associated with a higher risk of CV events in people with T2D, with adjusted hazard ratios (HRs) being 1.57 [95% CI (confidence interval): 1.39-1.78], 1.11 (95% CI 1.06-1.16), 1.46 (95% CI 1.36-1.57), and 1.78 (95% CI 1.57-2.01), respectively. In subgroup analyses, these positive associations appeared to be stronger among participants with body mass index (BMI) < 25 kg/m compared to overweight/obese participants. As for the predictive performance, CVAI had the largest C-statistic (0.700, 95% CI 0.672-0.728) compared to VAI, LAP, WC, and BMI (C-statistic: 0.535 to 0.670, all P for comparison < 0.05). When the abdominal obesity index was added to the basic risk model, the CVAI index also showed the greatest incremental risk stratification (C-statistic: 0.751 vs. 0.701, P < 0.001; IDI: 4.3%, P < 0.001; NRI: 26.6%, P < 0.001).
This study provided additional evidence that all abdominal obesity indices were associated with the risk of CV events and highlighted that CVAI might be a valuable abdominal obesity indicator for identifying the high risk of CV events in Chinese populations with T2D. These results suggest that proactive assessment of abdominal obesity could be helpful for the effective clinical management of the diabetic population.
腰围（WC）、内脏脂肪指数（VAI）、脂积指数（LAP）和中国内脏脂肪指数（CVAI）被认为是腹部脂肪沉积的替代指标，但这些指标与 2 型糖尿病（T2D）成人心血管（CV）事件的纵向关联仍不清楚。我们的研究旨在探讨 T2D 患者中这些腹部肥胖指标与 CV 事件的相关性，并比较它们在风险评估中的预测性能。
本研究纳入了来自新疆多民族队列的 2328 名 T2D 患者。采用多变量 Cox 回归分析评估腹部肥胖指标与 CV 事件之间的关系。采用 Harrell 一致性指数（C 统计量）、净重新分类改善（NRI）指数和综合判别改善（IDI）指数评估每个腹部肥胖指标的预测性能。
在中位随访 59 个月期间，289 名参与者发生了 CV 事件。经过多变量调整后，WC、VAI、LAP 和 CVAI 每增加 1-SD，T2D 患者发生 CV 事件的风险就会更高，调整后的危险比（HR）分别为 1.57[95%可信区间（CI）：1.39-1.78]、1.11（95%CI 1.06-1.16）、1.46（95%CI 1.36-1.57）和 1.78（95%CI 1.57-2.01）。在亚组分析中，与超重/肥胖参与者相比，BMI<25kg/m2的参与者中这些阳性关联似乎更强。就预测性能而言，与 VAI、LAP、WC 和 BMI（C 统计量：0.535 至 0.670，所有 P 值比较均<0.05）相比，CVAI 的 C 统计量（0.700，95%CI 0.672-0.728）最大。当将腹部肥胖指数添加到基本风险模型中时，CVAI 指数也显示出最大的增量风险分层（C 统计量：0.751 与 0.701，P<0.001；IDI：4.3%，P<0.001；NRI：26.6%，P<0.001）。
本研究提供了额外的证据表明，所有腹部肥胖指标均与 CV 事件风险相关，并强调 CVAI 可能是识别中国 T2D 人群 CV 事件高危风险的有价值的腹部肥胖指标。这些结果表明，积极评估腹部肥胖可能有助于对糖尿病患者进行有效的临床管理。
