Geriatric Medicine Center, Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Department of Endocrinology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, People's Republic of China.
Department of Endocrinology, Fenghua District Traditional Chinese Medicine Hospital of Ningbo, Ningbo, 315500, China.
Cardiovasc Diabetol. 2023 Jun 12;22(1):137. doi: 10.1186/s12933-023-01876-7.
Visceral obesity is associated with high cardiovascular events risk in type 2 diabetes mellitus (T2DM). Whether normal-weight visceral obesity will pose a higher atherosclerotic cardiovascular disease (ASCVD) risk than body mass index (BMI)-defined overweight or obese counterparts with or without visceral obesity remains unclear. We aimed to explore the relationship between general obesity and visceral obesity and 10-year ASCVD risk in patients with T2DM.
Patients with T2DM (6997) who satisfied the requirements for inclusion were enrolled. Patients were considered to have normal weight when 18.5 kg/m ≤ BMI < 24 kg/m; overweight when 24 kg/m ≤ BMI < 28 kg/m; and obesity when BMI ≥ 28 kg/m. Visceral obesity was defined as a visceral fat area (VFA) ≥ 100 cm. Patients were separated into six groups based on BMI and VFA. The odd ratios (OR) for a high 10-year ASCVD risk for different combinations of BMI and VFA were analysed using stepwise logistic regression. Receiver operating characteristic (ROC) curves for diagnosing the high 10-year ASCVD risk were constructed, and areas under the ROC curves were estimated. Potential non-linear relationships between VFA levels and high 10-year ASCVD risk were examined using restricted cubic splines (knot = 4). Multilinear regression was used to identify factors affecting VFA in patients with T2DM.
In patients with T2DM, subjects with normal-weight visceral obesity had the highest 10-year ASCVD risk among the six groups, which had more than a 2-fold or 3-fold higher OR than those who were overweight or obese according to BMI but did not have visceral obesity (all P < 0.05). The VFA threshold for high 10-year ASCVD risk was 90 cm. Multilinear regression showed significant differences in the effect of age, hypertension, drinking, fasting serum insulin, fasting plasma glucose, 2 h postprandial C-peptide, triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol on VFA in patients with T2DM (all P < 0.05).
T2DM patients with normal-weight visceral obesity had a higher 10-year ASCVD risk than BMI-defined overweight or obese counterparts with or without visceral obesity, which should initiate standardised management for ASCVD primary prevention.
内脏型肥胖与 2 型糖尿病（T2DM）患者的心血管事件风险升高有关。在有或无内脏型肥胖的情况下，体重指数（BMI）定义的超重或肥胖患者中，正常体重的内脏型肥胖是否比 BMI 定义的超重或肥胖患者具有更高的动脉粥样硬化性心血管疾病（ASCVD）风险尚不清楚。本研究旨在探讨 T2DM 患者中一般肥胖和内脏型肥胖与 10 年 ASCVD 风险之间的关系。
纳入符合纳入标准的 T2DM 患者（6997 例）。当 18.5 kg/m≤BMI＜24 kg/m 时，患者被认为是正常体重；24 kg/m≤BMI＜28 kg/m 时，患者被认为是超重；BMI≥28 kg/m 时，患者被认为是肥胖。内脏型肥胖定义为内脏脂肪面积（VFA）≥100 cm。根据 BMI 和 VFA，患者被分为六组。使用逐步逻辑回归分析不同 BMI 和 VFA 组合的高 10 年 ASCVD 风险的比值比（OR）。构建诊断高 10 年 ASCVD 风险的受试者工作特征（ROC）曲线，并估计 ROC 曲线下面积。使用限制性立方样条（结=4）检查 VFA 水平与高 10 年 ASCVD 风险之间的潜在非线性关系。多元线性回归用于确定影响 T2DM 患者 VFA 的因素。
在 T2DM 患者中，六组中正常体重的内脏型肥胖患者的 10 年 ASCVD 风险最高，与 BMI 定义的超重或肥胖但没有内脏型肥胖的患者相比，其 OR 超过 2 倍或 3 倍（均 P＜0.05）。VFA 诊断高 10 年 ASCVD 风险的阈值为 90 cm。多元线性回归显示，年龄、高血压、饮酒、空腹血清胰岛素、空腹血糖、餐后 2 小时 C 肽、甘油三酯、总胆固醇、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇对 T2DM 患者 VFA 的影响存在显著差异（均 P＜0.05）。
与 BMI 定义的超重或肥胖但无内脏型肥胖的患者相比，T2DM 合并正常体重的内脏型肥胖患者具有更高的 10 年 ASCVD 风险，应启动 ASCVD 一级预防的标准化管理。
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