在4C队列研究中，修正后的作用包括糖耐量状态在相对脂肪量与心血管疾病风险及全因死亡率之间关联中的中介和协同交互作用。

The modified role including mediating and synergistic interactive effects of glucose tolerance status in the associations between relative fat mass and the risks of cardiovascular disease and all-cause mortality from the 4C cohort study.

作者信息

Luo Peiqiong, Li Danpei, Guo Yaming, Meng Xiaoyu, Kan Ranran, Yu Xuefeng

机构信息

Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.

Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, 430030, Hubei, China.

出版信息

Diabetol Metab Syndr. 2024 Dec 26;16(1):313. doi: 10.1186/s13098-024-01558-8.

DOI:10.1186/s13098-024-01558-8

PMID:39726036

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11670452/

Abstract

BACKGROUND

To investigate the associations between relative fat mass (RFM) and clinical outcomes in different glucose tolerance statuses and the modified effect of glucose tolerance status.

METHODS

We analyzed 8,224 participants from a Chinese cohort study, who were classified into normal glucose status (NGT), prediabetes, and diabetes. Outcomes included fatal, nonfatal cardiovascular disease (CVD) events and all-cause mortality. Associations between RFM and outcomes were assessed using Cox regression. The modified effect of glucose tolerance status was investigated using mediation, interaction, and joint analyses.

RESULTS

During up to 5 years of follow-up, 154 (1.9%) participants experienced fatal CVD, 153 (1.9%) experienced nonfatal CVD events, and 294 (3.6%) experienced all-cause death. 2,679 participants (32.6%) had NGT, 4,528 (54.8%) had prediabetes, and 1,037 (12.6%) had diabetes. RFM was associated with increased risk of fatal (HR [95% CI], 1.09 [1.06-1.12], p < 0.001), nonfatal CVD events (HR [95% CI], 1.12 [1.09-1.15], p < 0.001), and all-cause mortality (HR [95% CI], 1.10 [1.08-1.12), p < 0.001) in all and those with NGT, prediabetes, and diabetes, and these associations were modified by glucose tolerance status, which included mediating (mediation proportion ranges from 4.74% to 8.69%) and synergistic interactive effects (multiplicative effect ranges from 1.03 to 1.06). The joint analysis identified the subclassification that exhibited the highest HR among 12 subclassifications.

CONCLUSIONS

RFM was associated with increased risk of fatal, nonfatal CVD events, and all-cause mortality in NGT, prediabetes, and diabetes, and these associations were modified by glucose tolerance status, which could significantly influence how clinicians assess high risk and could lead to more personalized, effective prevention strategies.

摘要

背景

探讨不同糖耐量状态下相对脂肪量（RFM）与临床结局之间的关联以及糖耐量状态的修正作用。

方法

我们分析了一项中国队列研究中的8224名参与者，他们被分为正常血糖状态（NGT）、糖尿病前期和糖尿病组。结局包括致命性、非致命性心血管疾病（CVD）事件和全因死亡率。使用Cox回归评估RFM与结局之间的关联。通过中介分析、交互作用分析和联合分析来研究糖耐量状态的修正作用。

结果

在长达5年的随访期间，154名（1.9%）参与者发生致命性CVD，153名（1.9%）发生非致命性CVD事件，294名（3.6%）经历全因死亡。2679名参与者（32.6%）为NGT，4528名（54.8%）为糖尿病前期，1037名（12.6%）为糖尿病。RFM与所有参与者以及NGT、糖尿病前期和糖尿病患者的致命性（HR [95% CI]，1.09 [1.06 - 1.12]，p < 0.001）、非致命性CVD事件（HR [95% CI]，1.12 [1.09 - 1.15]，p < 0.001）和全因死亡率（HR [95% CI]，1.10 [1.08 - 1.12]，p < 0.001）风险增加相关，并且这些关联被糖耐量状态所修正，其中包括中介作用（中介比例范围为4.74%至8.69%）和协同交互作用（相乘效应范围为1.03至1.06）。联合分析确定了12个亚组中HR最高的亚组分类。