Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
Department of Cardiology, Zhongshan-Xuhui Hospital, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, China.
Cardiovasc Diabetol. 2024 Jun 20;23(1):212. doi: 10.1186/s12933-024-02251-w.
This study sought to elucidate the associations of cardiometabolic index (CMI), as a metabolism-related index, with all-cause and cardiovascular mortality among the older population. Utilizing data from the National Health and Nutrition Examination Survey (NHANES), we further explored the potential mediating effect of inflammation within these associations.
A cohort of 3029 participants aged over 65 years old, spanning six NHANES cycles from 2005 to 2016, was enrolled and assessed. The primary endpoints of the study included all-cause mortality and cardiovascular mortality utilizing data from National Center for Health Statistics (NCHS). Cox regression model and subgroup analysis were conducted to assess the associations of CMI with all-cause and cardiovascular mortality. The mediating effect of inflammation-related indicators including leukocyte, neutrophil, lymphocyte, systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR) were evaluated to investigate the potential mechanism of the associations between CMI and mortality through mediation package in R 4.2.2.
The mean CMI among the enrolled participants was 0.74±0.66, with an average age of 73.28±5.50 years. After an average follow-up period of 89.20 months, there were 1,015 instances of all-cause deaths and 348 cardiovascular deaths documented. In the multivariable-adjusted model, CMI was positively related to all-cause mortality (Hazard Ratio (HR)=1.11, 95% CI=1.01-1.21). Mediation analysis indicated that leukocytes and neutrophils mediated 6.6% and 13.9% of the association of CMI with all-cause mortality.
Elevated CMI is positively associated with all-cause mortality in the older adults. The association appeared to be partially mediated through inflammatory pathways, indicating that CMI may serve as a valuable indicator for poor prognosis among the older population.
本研究旨在阐明代谢相关指数——心脏代谢指数（CMI）与老年人群全因和心血管死亡率之间的关联。我们利用来自国家健康和营养检查调查（NHANES）的数据，进一步探讨了这些关联中炎症的潜在中介作用。
纳入了 3029 名年龄在 65 岁以上的参与者，这些参与者来自于 2005 年至 2016 年的六个 NHANES 周期。研究的主要终点是利用国家卫生统计中心（NCHS）的数据评估全因死亡率和心血管死亡率。采用 Cox 回归模型和亚组分析评估 CMI 与全因和心血管死亡率的关联。使用 R 4.2.2 中的中介包评估炎症相关指标（包括白细胞、中性粒细胞、淋巴细胞、全身免疫炎症指数（SII）、中性粒细胞与淋巴细胞比值（NLR））的中介效应，以探讨 CMI 与死亡率之间关联的潜在机制。
纳入的参与者的平均 CMI 为 0.74±0.66，平均年龄为 73.28±5.50 岁。在平均 89.20 个月的随访后，记录了 1015 例全因死亡和 348 例心血管死亡。在多变量调整模型中，CMI 与全因死亡率呈正相关（危险比（HR）=1.11，95%置信区间（CI）=1.01-1.21）。中介分析表明，白细胞和中性粒细胞介导了 CMI 与全因死亡率关联的 6.6%和 13.9%。
在老年人中，升高的 CMI 与全因死亡率呈正相关。这种关联似乎部分通过炎症途径介导，表明 CMI 可能是老年人群不良预后的一个有价值的指标。
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