Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom.
Am J Physiol Heart Circ Physiol. 2023 Jun 1;324(6):H905-H911. doi: 10.1152/ajpheart.00126.2023. Epub 2023 Apr 21.
The temporal longitudinal associations of carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness, with the risk of incident metabolic syndrome, were examined in youth. A total of 3,862 adolescents, aged 17.7 yr and followed up for 7 yr, from the Avon Longitudinal Study of Parents and Children were included. cfPWV was assessed by Vicorder at baseline and follow up. Metabolic syndrome was determined by the presence of three or more of dual-energy X-ray absorptiometry-measured trunk fat obesity; decreased high-density lipoprotein cholesterol, elevated triglyceride, hyperglycemia, and elevated/hypertensive blood pressure at both measurement time points. Analyses were conducted using generalized logit mixed-effect models and autoregressive cross-lagged and mediation structural equation models. Among 3,862 adolescents [2,143 (55.5%) female], 5% of male and 1.1% of female participants had metabolic syndrome at baseline, whereas 8.8% of male and 2.4% of female participants had metabolic syndrome at follow-up. In the mixed-model analysis, a 7-yr progressive increase in cfPWV was associated with a cumulatively increased risk of incident metabolic syndrome from baseline through follow-up in the total cohort (odds ratio 1.04 [confidence interval, 1.02-1.06], = 0.002) and in males (1.09 [1.06-1.12], < 0.001) but not in females (1.01 [0.95-1.06], = 0.885). In the cross-lagged model, higher cfPWV at baseline was associated with a higher metabolic syndrome score (β = 0.08, standard error = 0.39, < 0.0001) at follow-up but metabolic syndrome score at baseline was not associated with cfPWV at follow-up. Cumulatively increased fasting insulin and low-density lipoprotein cholesterol had 12.4 and 9.4% respective mediation effects on the positive relationships between cumulative arterial stiffness and metabolic syndrome score. In conclusion, arterial stiffness temporally preceded incident and progressive metabolic syndrome in youth in a potential causal path, but experimental studies are warranted. Participants at risk of metabolic syndrome increased twofold during growth from late adolescence to young adulthood. The cumulative increase in arterial stiffness independently predicted the progressive risk of incident metabolic syndrome. Arterial stiffness temporally preceded metabolic syndrome. Increased fasting insulin and low-density lipoprotein cholesterol partly mediated the direct associations between arterial stiffness and metabolic syndrome. Age 17 yr may be an optimal arterial stiffness intervention timing for attenuating metabolic syndrome risks.
动脉僵硬度的一个衡量指标——颈股脉搏波速度（cfPWV）与青年人群代谢综合征发病风险的纵向关联，在本研究中得到了检验。本研究共纳入了 3862 名年龄在 17.7 岁的青少年，他们来自于阿冯纵向研究的父母和儿童队列，随访时间为 7 年。基线和随访时均采用 Vicorder 评估 cfPWV。代谢综合征通过双能 X 射线吸收法测量的躯干部位脂肪肥胖、高密度脂蛋白胆固醇降低、甘油三酯升高、血糖升高和血压升高（在两个测量时间点均升高/血压升高）的三或更多项来确定。采用广义对数混合效应模型和自回归交叉滞后及中介结构方程模型进行分析。在 3862 名青少年中[2143 名（55.5%）为女性]，5%的男性和 1.1%的女性在基线时患有代谢综合征，而 8.8%的男性和 2.4%的女性在随访时患有代谢综合征。在混合模型分析中，cfPWV 在 7 年内逐渐增加与总队列中从基线到随访期间代谢综合征发病风险的累积增加相关（比值比 1.04[95%置信区间，1.02-1.06]， = 0.002），在男性中也是如此（1.09[1.06-1.12]， < 0.001），但在女性中并非如此（1.01[0.95-1.06]， = 0.885）。在交叉滞后模型中，基线时 cfPWV 较高与随访时代谢综合征评分较高相关（β=0.08，标准误差=0.39， < 0.0001），但基线时的代谢综合征评分与随访时的 cfPWV 无关。累积空腹胰岛素和低密度脂蛋白胆固醇分别对累积动脉僵硬度与代谢综合征评分之间的正相关关系具有 12.4%和 9.4%的部分中介作用。总之，动脉僵硬度在青年人群代谢综合征发病和进展之前存在时间上的先后关系，可能存在因果关系，但需要进行实验研究。在从青春期后期到成年早期的生长过程中，代谢综合征风险增加了两倍。动脉僵硬度的累积增加独立预测了代谢综合征发病风险的进展。动脉僵硬度在代谢综合征之前发生。空腹胰岛素和低密度脂蛋白胆固醇升高部分介导了动脉僵硬度与代谢综合征之间的直接关联。17 岁可能是动脉僵硬度干预以降低代谢综合征风险的最佳时机。
