Wang Meixiao, Liu Shihe, Liu Luqing, Wen Xinran, Liao Yicheng, Liu Hongmin, Wu Shouling, Wu Yuntao
Department of Cardiology, Kailuan General Hospital, Tangshan, China.
School of Graduate Studies, North China University of Science and Technology, Tangshan, China.
Endocrine. 2025 Mar 27. doi: 10.1007/s12020-025-04197-9.
Plasma atherogenic index is a major risk factor for cardiac metabolic disease, but the long-term effect of high cumAIP on the risk of CMD development is unclear. Therefore, we aimed to determine the effect of cumulative plasma atherogenic index exposure on cardiac metabolic disease.
A total of 44,603 subjects who participated in the Kailuan Study health examination in 2006, 2008 and 2010, had complete blood lipid data, and had no previous history of CMD or cancer were selected. The cumulative AIP index was calculated as a weighted sum (value × time) of the average AIP index during each time interval. The population was divided into four groups according to the cumAIP quartile level. Cox proportional hazards regression model and restricted cubic spline regression model were used to further analyze the effect of cumAIP on the risk of CMD. Due to the competing risk of death, the traditional Cox model may cause bias on the risk of CMD. Therefore, death was regarded as a competing event, and the Fine-Gray model was used to analyze the difference in the risk of CMD in different cumAIP groups.
During a mean follow-up period of (9.79 ± 2.60) years, 7674 (17.21%) of 44603 participants developed CMD. After adjusting for potential confounding factors, Cox regression analysis showed that compared with group Q1, the risk of CMD in group Q2, Q3, and Q4 increased by 26% (HR = 1.26, 95%CI: 1.17-1.36) and 44% (HR = 1.44, 95%CI: 1.17-1.36), respectively. 95%CI: 1.34-1.55), 83% (HR = 1.83, 95%CI: 1.70-1.96). Each standard deviation increase in the risk of myocardial infarction, revascularization, ischemic stroke, and type 2 diabetes was 1.25 (1.15, 1.36), 1.19 (1.12, 1.26), 1.08 (1.03, 1.13), and 1.35 (1.31, 1.39) for cumAIP, respectively.
There was a significant association between high levels of cumAIP exposure and higher risk of CMD. The effect of long-term exposure to high levels of cumAIP on increasing the risk of CMD was more obvious in the low-risk population.
血浆致动脉粥样硬化指数是心脏代谢疾病的主要危险因素，但累积高致动脉粥样硬化指数血浆（cumAIP）对心脏代谢疾病（CMD）发生风险的长期影响尚不清楚。因此，我们旨在确定累积血浆致动脉粥样硬化指数暴露对心脏代谢疾病的影响。
选取2006年、2008年和2010年参加开滦研究健康体检、有完整血脂数据且既往无CMD或癌症病史的44603名受试者。累积AIP指数计算为每个时间间隔内平均AIP指数的加权和（值×时间）。根据cumAIP四分位数水平将人群分为四组。采用Cox比例风险回归模型和受限立方样条回归模型进一步分析cumAIP对CMD风险的影响。由于存在死亡的竞争风险，传统Cox模型可能会在CMD风险上产生偏差。因此，将死亡视为竞争事件，采用Fine-Gray模型分析不同cumAIP组中CMD风险的差异。
在平均随访（9.79±2.60）年期间，44603名参与者中有7674名（17.21%）发生CMD。在调整潜在混杂因素后，Cox回归分析显示，与Q1组相比，Q2组、Q3组和Q4组发生CMD的风险分别增加26%（HR = 1.26，95%CI：1.17 - 1.36）、44%（HR = 1.44，95%CI：1.34 - 1.55）、83%（HR = 1.83，95%CI：1.70 - 1.96）。cumAIP每增加一个标准差，心肌梗死、血运重建、缺血性卒中和2型糖尿病风险分别增加1.25（1.15，1.36）、1.19（1.12，1.26）、1.08（1.03，1.13）和1.35（1.31，1.39）。
高水平的cumAIP暴露与更高的CMD风险之间存在显著关联。长期暴露于高水平cumAIP对增加CMD风险的影响在低风险人群中更为明显。
