Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran Iran.
Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine Wake Forest University School of Medicine Winston Salem NC USA.
J Am Heart Assoc. 2024 Jul 2;13(13):e033355. doi: 10.1161/JAHA.123.033355. Epub 2024 Jun 6.
The aim of this study was to assess how early-adulthood body mass index (BMI) and waist circumference (WC) relate to long-term cardiovascular structure, function, and prognosis in individuals without obesity and with low cardiovascular risk factor (CVRF) burden.
A total of 2024 participants aged 18 to 30 from the CARDIA (Coronary Artery Risk Development in Young Adults) study, without obesity and with low CVRFs defined as the absence of cardiovascular disease (CVD), diabetes, hypertension, current smoking, and dyslipidemia were included. A CVRF-optimal subgroup was also defined, with blood pressure<120/80 mm Hg, fasting glucose <100 mg/dL, total cholesterol <200, low-density lipoprotein cholesterol <130, and women with high-density lipoprotein cholesterol ≥50 mg/dL. Coronary artery calcification, carotid intima-media thickness, left ventricular mass, left ventricular ejection fraction, longitudinal peak systolic strain, and diastolic function were assessed in midlife. Cox regression was used to calculate hazard ratios of BMI and WC for all-cause death and CVD events. Logistic regression was used to estimate odds ratios for subclinical CVD. Over 33.9 years (median follow-up), 5.2% (n=105) died, and 2.6% (n=52) had CVD events. Each 1-SD BMI increase was associated with 27% (95% CI, 1.10-1.47), 24% (1.08-1.43), 42% (1.20-1.68), 28% (1.05-1.57), 51% (1.20-1.90), and 49% (1.10-2.02) higher odds of coronary artery calcification presence, increased carotid intima-media thickness, left ventricular hypertrophy, reduced left ventricular ejection fraction, low longitudinal peak systolic strain, and diastolic dysfunction, respectively, in the CVRF-low group. Generally, similar associations were found for WC and in the CVRF-optimal subgroup. No significant associations between BMI and WC with CVD and death were found.
Elevations in BMI and WC among young low-risk individuals, even within the nonobesity range, are associated with midlife cardiovascular health.
本研究旨在评估成年早期的体重指数（BMI）和腰围（WC）与非肥胖且心血管风险因素（CVRF）负担低的个体的长期心血管结构、功能和预后的关系。
共纳入 2024 名年龄在 18 至 30 岁的 CARDIA（年轻人冠状动脉风险发展）研究参与者，无肥胖且 CVRF 低定义为无心血管疾病（CVD）、糖尿病、高血压、当前吸烟和血脂异常。还定义了一个 CVRF 最佳亚组，血压<120/80mmHg，空腹血糖<100mg/dL，总胆固醇<200，低密度脂蛋白胆固醇<130，女性高密度脂蛋白胆固醇≥50mg/dL。在中年评估冠状动脉钙化、颈动脉内膜中层厚度、左心室质量、左心室射血分数、纵向收缩期峰值应变和舒张功能。使用 Cox 回归计算 BMI 和 WC 与全因死亡和 CVD 事件的风险比。使用逻辑回归估计亚临床 CVD 的优势比。中位随访 33.9 年期间，有 5.2%（n=105）死亡，2.6%（n=52）发生 CVD 事件。BMI 每增加 1 个标准差，与冠状动脉钙化存在的几率增加 27%（95%CI，1.10-1.47）、24%（1.08-1.43）、42%（1.20-1.68）、28%（1.05-1.57）、51%（1.20-1.90）和 49%（1.10-2.02）相关，在 CVRF 低组中，颈动脉内膜中层厚度增加、左心室肥厚、左心室射血分数降低、纵向收缩期峰值应变降低和舒张功能障碍的几率也分别增加。一般来说，WC 也存在类似的关联，在 CVRF 最佳亚组中也是如此。BMI 和 WC 与 CVD 和死亡之间无显著相关性。
即使在非肥胖范围内，年轻低危个体的 BMI 和 WC 升高也与中年心血管健康有关。
