老年高血压人群腰围身高比与新发脑梗死的关系

doi:10.3969/j.issn.1006-5725.2024.11.021

Abstract

Abstract:

Objective To study the relationship between waist-to-height ratio （WHtR） and new-onset cerebral infarction in the elderly with hypertension. Methods A total of 9 096 elderly hypertensive patients were enrolled from the Kailuan study population. Using the first occurrence of cerebral infarction as the endpoint event， a prospective cohort study was performed. According to the WHtR value of the subjects with an interval of 0.05， the subjects were divided into G1 group （WHtR < 0.45）， G2 group （0.45 ≤ WHtR < 0.50）， G3 group （0.50 ≤ WHtR < 0.55）， and G4 group （WHtR ≥ 0.55）. The cumulative incidence rate of endpoint event in each population were statistically analyzed using the life table method. Cox proportional hazards regression analysis was used to explore the role of WHtR in the occurrence of new cerebral infarction. Model 1 was a single factor Cox proportional hazards analysis model， only considering the influence of WHtR on the risk of cerebral infarction. After adjusting sex， age， body weight， serum hypersensitive C-reactive protein， systolic blood pressure， serum triglycerides， smoking history， fasting blood glucose， alcohol consumption， high-density lipoprotein cholesterol， diastolic blood pressure， exercise， low-density lipoprotein cholesterol， educational level， antihypertensive drug history， model 2 was established to observe the influence of WHtR on the occurrence of new-onset cerebral infarction. Results The follow-up lasted （9.3 ± 2.7）years. Compared to the G2 group， multivariateCox proportional hazards regression model showed that the hazard ratio HR（95%CI） for cerebral infarction in model 1 was 1.00（0.67 ~ 1.50）， 1.29 （1.05 ~ 1.60） and 1.36（1.12 ~ 1.66） respectively in G1， G3 and G4； and that in model 2 was 1.09 （0.72 ~ 1.65）， 1.24（0.99 ~ 1.54） and 1.31（1.05 ~ 1.62） respectively in G1， G3 and G4. Conclusion The risk of cerebral infarction in the elderly with hypertension is the lowest when WHtR between 0.45 ≤ WHtR < 0.50， and WHtR greater than or equal to 0.55 is associated with an increased risk of new-onset cerebral infarction.

Key words: waist to height ratio, cerebral infarction, senile hypertension, cohort study

CLC Number:

R743.3

Xiaobin GUO,Ping LIU,Wenxia. YU. The association between the waist⁃to⁃height ratio and novel cerebral infarction in the elderly with hypertension[J]. The Journal of Practical Medicine, 2024, 40(11): 1592-1596.

Figures/Tables 2

Tab.1

Tab.2

References 28

1	王拥军，李子孝，谷鸿秋，等. 《中国卒中报告》编写委员会. 中国卒中报告2020 （中文版）（3）［J］.中国卒中杂志， 2022，17（7）：675-682.
2	国家统计局. 《第七次全国人口普查主要数据结果新闻发布会答记者问》［R/OL］（2021-05-11）［2023-09-23］. http： / /.
3	ZICCARDI P， NAPPO F， GIUGLIANO G， et al. Reduction of infammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year［J］. Circulation， 2002， 105（7）：804-809. doi:10.1161/hc0702.104279 doi: 10.1161/hc0702.104279
4	DESPRES J P， LEMIEUX I. Abdominal obesity and metabolic syndrome［J］. Nature， 2006， 444（7121）：881-887. doi:10.1038/nature05488 doi: 10.1038/nature05488
5	TAUBE A， SCHLICH R， SELL H， et al. Infammation and metabolic dysfunction： links to cardiovascular diseases［J］. Am J Physiol Heart Circ Physiol， 2012， 302（11）：H2148. doi:10.1152/ajpheart.00907.2011 doi: 10.1152/ajpheart.00907.2011
6	TSUJIMOTO T， KAJIO H. Abdominal obesity is associated with an increased risk of all-cause mortality in patients with HFpEF［J］. J Am Coll Cardiol， 2017， 70（22）：2739-2749. doi:10.1016/j.jacc.2017.09.1111 doi: 10.1016/j.jacc.2017.09.1111
7	HAYKOWSKY M J， NICKLAS B J， BRUBAKER P H， et al. Regional adipose distribution and its relationship to exercise intolerance in older obese patients who have heart failure with preserved ejection fraction［J］. JACC Heart Fail， 2018， 6（8）：640-649. doi:10.1016/j.jchf.2018.06.002 doi: 10.1016/j.jchf.2018.06.002
8	GARVEY W T， GARBER A J， MECHANICK J I， et al. American association of clinical endocrinologists and American college of endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease［J］. Endocr Pract， 2014， 20（9）：977-989. doi:10.4158/ep14280.ps doi: 10.4158/ep14280.ps
9	HEYMSFELD S B， PETERSON C M， THOMAS D M， et al. Why are there race/ethnic diferences in adult body mass index-adiposity relationships？ A quantitative critical review［J］. Obes Rev， 2016， 17（3）：262-275. doi:10.1111/obr.12358 doi: 10.1111/obr.12358
10	LE C E DA， FATEMIFAR G， PALMER T M， et al.. Causal associations of adiposity and body fat distribution with coronary heart disease， stroke subtypes， and type 2 diabetes mellitus： a mendelian randomization analysis［J］. Circulation， 2017， 135（24）：2373-2388. doi:10.1161/circulationaha.116.026560 doi: 10.1161/circulationaha.116.026560
11	ZENG Q， HE Y， DONG S， et al. Optimal cut-of values of BMI， waist circumference and waist：height ratio for defning obesity in Chinese adults［J］. Br J Nutr， 2014， 112：1735-1744. doi:10.1017/s0007114514002657 doi: 10.1017/s0007114514002657
12	赵方蕾. 中国65岁及以上老年人膳食营养现况及糖尿病膳食影响因素分析［D］. 北京：中国疾病预防控制中心，2021.
13	WU S， HUANG Z， YANG X， et al. Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a northern Chinese industrial city ［J］. Circ Cardiovasc Qual Outcomes， 2012， 5（4）： 487-493. doi:10.1161/circoutcomes.111.963694 doi: 10.1161/circoutcomes.111.963694
14	WU S， LI Y， JIN C， et al. Intra-individual variability of high-sensitivity C-reactive protein in Chinese general population ［J］. Int J Cardiol， 2012， 157（1）： 75-79. doi:10.1016/j.ijcard.2010.12.019 doi: 10.1016/j.ijcard.2010.12.019
15	刘苹，郭晓斌，吴寿岭，等. 高龄老年高血压人群收缩压与全因死亡的关系［J］. 实用老年医学， 2020，34（5）：472-475+478. doi:10.3969/j.issn.1003-9198.2020.05.016 doi: 10.3969/j.issn.1003-9198.2020.05.016
16	李春盛，陈有仁，宋路，等. 收缩压与缺血性心血管病10年发病危险度对老年高血压人群全因死亡的影响［J］. 中华高血压杂志，2019，27（2）：179-183.
17	中国高血压防治指南修订委员会. 中国高血压防治指南 2010 ［J］. 中华心血管病杂志， 2011， 39（7）： 579-616.
18	ZHANG F L， REN J X， ZHANG P， et al. Strong Association of Waist Circumference （WC）， Body Mass Index （BMI）， Waist-to-Height Ratio （WHtR）， and Waist-to-Hip Ratio （WHR） with Diabetes： A Population-Based Cross-Sectional Study in Jilin Province， China［J］. J Diabetes Res， 2021， 2021：8812431. doi:10.1155/2021/8812431 doi: 10.1155/2021/8812431
19	MOLTRER M， PALA L， COSENTINO C， et al. Body mass index （BMI）， waist circumference （WC）， waist-to-height ratio （WHtR） e waist body mass index （wBMI）： Which is better？［J］. Endocrine， 2022， 76（3）：578-583. doi:10.1007/s12020-022-03030-x doi: 10.1007/s12020-022-03030-x
20	张鹏，张华，胡扬喜，等. 中国人内脏脂肪指数与肥胖合并阻塞性睡眠呼吸暂停的相关性及预测价值［J］. 实用医学杂志，2023，39（17）：2210-2214. doi:10.3969/j.issn.1006-5725.2023.17.010 doi: 10.3969/j.issn.1006-5725.2023.17.010
21	ASHWELL M， GUNN P， GIBSON S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors： systematic review and meta-analysis［J］. Obes Rev， 2012， 13（3）：275-2786. doi:10.1111/j.1467-789x.2011.00952.x doi: 10.1111/j.1467-789x.2011.00952.x
22	赵连成，李莹，彭亚光，等. 中国成人中心性肥胖腰围身高比值的适宜切点的研究［J］. 中国预防医学杂志，2012，13（7）：481-485：2305259.
23	CAO L， ZHOU J， CHEN Y， et al. Effects of Body Mass Index， Waist Circumference， Waist-to-Height Ratio and Their Changes on Risks of Dyslipidemia among Chinese Adults： The Guizhou Population Health Cohort Study［J］. Int J Environ Res Public Health， 2021， 19（1）：341. doi:10.3390/ijerph19010341 doi: 10.3390/ijerph19010341
24	CHEN J， LI M， HAO B， et al. Waist to height ratio is associated with an increased risk of mortality in Chinese patients with heart failure with preserved ejection fraction［J］. BMC Cardiovasc Disord， 2021， 21（1）：263. doi:10.1186/s12872-021-02080-9 doi: 10.1186/s12872-021-02080-9
25	ZHANG L， CHEN B， XIE X， et al. Association of Waist-to-Height Ratio， Metabolic Syndrome， and Carotid Atherosclerosis in Individuals with a High Risk of Stroke： A Cross-Sectional Study of 9605 Study Participants［J］. Metab Syndr Relat Disord， 2020， 18（8）：381-388. doi:10.1089/met.2020.0003 doi: 10.1089/met.2020.0003
26	FONTANA L， EAGON J C， TRUJILLO M E， et al. Visceral fat adipokine secretion is associated with systemic infammation in obese humans［J］. Diabetes， 2007， 56（4）：1010-1013. doi:10.2337/db06-1656 doi: 10.2337/db06-1656
27	郭晓斌，刘苹，杨浩辉，等. 老年高血压人群身高与新发脑梗死关系［J］. 实用医学杂志， 2023，39（13）：1714-1718. doi:10.3969/j.issn.1006-5725.2023.13.021 doi: 10.3969/j.issn.1006-5725.2023.13.021
28	LIN M， ZHOU S， GU S. Association between dynamic change patterns of body mass or fat mass and incident stroke： results from the China Health and Retirement Longitudinal Study （CHARLS）［J］. Front Cardiovasc Med， 2023， 10：1269358. doi:10.3389/fcvm.2023.1269358 doi: 10.3389/fcvm.2023.1269358

特点	G1组（n = 389）	G2组（n = 1 708）	G3组（n = 2 863）	G4组（n = 4 136）	F/χ ² 值	P值
年龄（岁）	71.3 ± 5.2	71.2 ± 5.5	71.2 ± 5.3	71.6 ± 5.4	2.539	0.049
男性［例（%）］	351（90.2）	1 568（91.8）	2 561（89.5）	3 476（84.0）	86.765	< 0.000 1
SBP（mmHg）	151.80 ± 16.59	153.49 ± 17.99	153.67 ± 18.17	154.38 ± 17.45	3.078	0.020
DBP（mmHg）	87.25 ± 10.62	87.84 ± 10.54	88.43 ± 10.64	88.97 ± 10.60	6.770	< 0.000 1
lgTG	0.00 ± 0.23	0.05 ± 0.23	0.12 ± 0.24	0.18 ± 0.24	179.075	< 0.000 1
LDL-C（mmol/L）	2.40 ± 1.12	2.38 ± 0.95	2.36 ± 1.01	2.33 ± 1.13	1.499	0.215
HDL-C（mmol/L）	1.69 ± 0.45	1.65 ± 0.46	1.61 ± 0.45	1.57 ± 0.48	18.663	< 0.000 1
FBG（mmol/L）	5.35 ± 1.75	5.52 ± 1.90	5.66 ± 1.92	5.83 ± 2.01	15.405	< 0.000 1
BMI（kg/m²）	20.63 ± 3.49	22.69 ± 2.74	24.38 ± 2.47	27.21 ± 3.24	1 445.867	< 0.000 1
lghsCRP	0.08 ± 0.68	0.05 ± 0.68	0.14 ± 0.63	0.28 ± 0.62	80.178	< 0.000 1
教育程度［例（%）］					17.928	0.007
文盲/小学	122（31.8）	485（29.2）	820（29.6）	1305（33.4）
中学	252（65.6）	1 112（66.9）	1 836（66.2）	2 450（62.7）
大专或以上	10（2.6）	65（3.9）	1184.3）	154（3.9）
体育锻炼［例（%）］	116（30.9）	417（25.6）	796（29.6）	982（26.3）	14.307	0.003
饮酒史［例（%）］	140（36.2）	541（32.0）	994（35.0）	1 318（32.5）	7.679	0.053
吸烟史［例（%）］	104（26.8）	366（21.7）	586（20.7）	678（16.7）	40.262	< 0.000 1
服降压药物史［例（%）］	99（25.4）	555（32.5）	1 140（39.8）	1 909（46.2）	136.979	< 0.000 1

指标	G1组（n = 389）	G2组（n = 1 708）	G3组（n = 2 863）	G4组（n = 4 136）	P值
累积脑梗死发病率［例（%）］	29（8.8）	127（9.8）	276（11.7）	416（12.6）
#HR（95%CI）	1.00（0.67 ~ 1.50）	1	1.29（1.05 ~ 1.60）	1.36（1.12 ~ 1.66）	0.012
P值	0.994		0.016	0.002
β	-0.002		0.258	0.308
SE	0.206		0.107	0.101
Wald	0.000		5.768	9.281
￥HR（95%CI）	1.09（0.72 ~ 1.65）	1	1.24（0.99 ~ 1.54）	1.31（1.05 ~ 1.62）	0.099
P值	0.673		0.059	0.015
β	0.089		0.212	0.267
SE	0.211		0.112	0.109
Wald	0.178		3.578	5.969

[1]	Song LI,Xingyou HE,Dian HE,Bo WANG,Yu ZHAN,Jingjing. SUN. The joint efficacy of NBP and LIPost C in treatment of elderly patients with large atherosclerotic cerebral infarction [J]. The Journal of Practical Medicine, 2024, 40(9): 1286-1292.
[2]	Xiaoya YANG,Tianqi HONG,Kaili GE,Renjie ZHANG,Chunshan. WEI. Long⁃term prognosis analysis of chronic hepatitis B patients followed up for 25 years：Retrospective cohort study [J]. The Journal of Practical Medicine, 2024, 40(7): 962-965.
[3]	Xiangzhi XIAO,Guanxiong CHEN,Zhiwen HU. The relationship between EGCG targeted regulation of Nrf2⁃Keap1 signaling pathway and neuroprotective effect in cerebral infarction [J]. The Journal of Practical Medicine, 2024, 40(3): 309-315.
[4]	Zhe SHI,Xialin ZUO,Linhui PENG,Zhiwei LU,Kongping. LI. Effect of M1 microglial polarization on secondary damage in the thalamus after cerebral cortical infarction [J]. The Journal of Practical Medicine, 2024, 40(22): 3138-3145.
[5]	Guidi ZOU,Xiaokai CHEN,Huihong TAN,Yi LI,Nan LI,Yefan CAO,Hewei. WANG. The clinical efficacy of closed⁃loop rehabilitation therapy by brain⁃computer interface combined with exoskeleton robotic hand for patients with hand dysfunction after cerebral infarction [J]. The Journal of Practical Medicine, 2024, 40(17): 2395-2400.
[6]	Juan DU,Xiaoyu ZHOU,Miao ZHANG,Xueling ZHANG,Wenya. LAN. Impact of mechanical thrombectomy using Solitaire stent combined with dual antiplatelet therapy on limb function and vascular reocclusion in patients with acute cerebral infarction [J]. The Journal of Practical Medicine, 2024, 40(14): 1952-1956.
[7]	Yiyuan LIU,Jinyuan. MAO. Progress in researches on association between selenium nutritional status and dyslipidemia [J]. The Journal of Practical Medicine, 2024, 40(13): 1889-1894.
[8]	Zijuan FU,Qian LI,Lin LU,Yongqiu. LI. Relationship of serum ANGPTL3 and NFATc1 levels with the severity and prognosis in cerebral infarction patients [J]. The Journal of Practical Medicine, 2024, 40(10): 1407-1411.
[9]	Yinbi ZHENG,Yiming SHAO,Zhaoji LI,Shiting LI,Mingdi CHEN,Wenchi ZENG,Hongyu. DONG. Effect of dexmedetomidine on renal function in patients with septic⁃associated acute kidney injury： A cohort study [J]. The Journal of Practical Medicine, 2024, 40(10): 1423-1428.
[10]	GUO Xiaobin, LIU Ping, YANG Haohui, ZHAO Jing, KAN Chunna, ZHAI Jingxiu, YU Wenxia, ZHAO Chumin, LIU Zhiwei.. The association between the body height and novel cerebral infarction in the elderly with hypertension [J]. The Journal of Practical Medicine, 2023, 39(13): 1714-1718.
[11]	NIU Wen, QIU Xiaohui, LIU Yichao.. Relationship between perivascular fat density of carotid artery stenosis and cerebral infarction [J]. The Journal of Practical Medicine, 2023, 39(1): 103-108.
[12]	HUANG Jianmin, YUN Yanfang, YANG Guixin, CHEN Haiyan, JIANG Yongming, HUANG Dongxu, LIU Jie, MO Xiaorong, LI Xuebin.. Effects of survivin inhibitor YM155 on microvessel density and angiogenesis⁃related gene expression in rats with cerebral infarction [J]. The Journal of Practical Medicine, 2022, 38(8): 946-951.
[13]	TONG Luyao, LEI Liyi, CHEN Jun, HUANG Weiling, ZHANG Mei. . Metabolic syndrome and its components and the risk of ovarian cancer in women：A single center prospec⁃ tive cohort study [J]. The Journal of Practical Medicine, 2022, 38(10): 1280-1285.
[14]	WU Fan, WU Huazhen, HUANG Zhihui, ZHOU Dabiao, YE Xuhao, LI Zhigang.. Preventive effect of Bushen Zhuanggu Pill on recollapses of cemented vertebrae after primary vertebroplasty [J]. The Journal of Practical Medicine, 2022, 38(1): 111-115.
[15]	NIE Daao, LIN Qiaowen, TAN Wenhui, LI Yangfeng, HUANG Jianxin. . The predictive value of remnant cholesterol level in patients with acute cerebral infarction [J]. The Journal of Practical Medicine, 2021, 37(13): 1711-1718.

The association between the waist⁃to⁃height ratio and novel cerebral infarction in the elderly with hypertension

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 2

References 28

Related Articles 15

Recommended Articles

Metrics

Comments