血浆致动脉粥样硬化指数及其人体测量学衍生指标AIP-WHtR、AIP-BRI与中老年人群脑卒中发病风险的队列研究

Aü cohort study on the association between the atherogenic index of plasma and its anthropometric-derived indicators AIP-WHtR, AIP-BRI and the risk of stroke in middle-aged and elderly populations

摘要:

目的]探索血浆致动脉粥样硬化指数(AIP)及其人体测量学衍生指标AIP-腰围身高比(AIP-WHtR)、AIP-身体圆度指数(AIP-BRI)与中老年人群脑卒中长期发病风险之间的关联。 [方法]研究人群来源于中国健康与养老追踪调查。通过自我报告的问卷数据确定新发脑卒中。采用酶催化显色法测定参与者血液中的甘油三酯(TG)及高密度脂蛋白胆固醇(HDLC)水平,并计算AIP及其人体测量学衍生指标AIP-WHtR和AIP-BRI。采用Cox比例风险回归来评估累积和分类的AIP及其人体测量学衍生指标AIP-WHtR、AIP-BRI与脑卒中发生之间的关联。使用限制性立方样条来探讨累积AIP及其人体测量学衍生指标AIP-WHtR、AIP-BRI与脑卒中风险之间潜在的非线性关系。 [结果]8 454名参与者的平均年龄为(60.65±9.29)岁,中位随访7年期间,共670名参与者(7.93%)新发脑卒中。在完全调整混杂因素后,AIP每升高1个标准差,脑卒中风险增加21%(HR＝1.21,95%CI:1.09～1.33,P＜0.001)。同样,较高水平的AIP-WHtR(HR＝1.40,95%CI:1.18～1.66,P＜0.001)和AIP-BRI(HR＝1.04,95%CI:1.02～1.06,P＜0.001)均与脑卒中风险增加呈正相关。限制性立方样条分析显示,AIP及其人体测量学衍生指标AIP-WHtR、AIP-BRI与脑卒中风险之间存在正向剂量-反应关系,且呈现显著的非线性趋势。此外,亚组分析进一步证实,男性中较高水平的AIP与脑卒中风险升高相关(HR＝1.25,95%CI:1.08～1.44,P＜0.001),而女性中AIP水平与脑卒中风险的关联不显著(HR＝1.15,95%CI:1.00～1.32,P＝0.050)。 [结论]中老年人群中,较高水平的AIP及其人体测量学衍生指标AIP-WHtR、AIP-BRI均与脑卒中风险增加呈正相关,这些指数或可作为有效的脑卒中风险评估工具。

Abstract:

Aim To explore the association between atherogenic index of plasma (AIP) and its anthropometric-derived indicators AIP-waist-to-height ratio (AIP-WHtR) and AIP-body roundness index (AIP-BRI) and the long-term risk of stroke in middle-aged and elderly populations. Methods The study population was derived from the China Health and Retirement Longitudinal Study. Incident stroke cases were identified through self-reported questionnaire data.Enzyme-catalyzed colorimetric method was used to measure the levels of triglyceride (TG) and high density lipoprotein cholesterol (HDLC) in the blood of participants, and AIP and its anthropometric-derived indicators AIP-WHtR and AIP-BRI were calculated. Cox proportional hazards regression was used to evaluate the association between cumulative and categorical AIP and its anthropometric-derived indicators AIP-WHtR, AIP-BRI and stroke occurrence. Restrictied cubic spline was used to explore the potential nonlinear relationships between cumulative AIP and its anthropometric-derived indicators AIP-WHtR, AIP-BRI and the risk of stroke. Results The average age of 8 454 participants was (60.65±9.29) years, and during a median follow-up period of 7 years, a total of 670 participants (7.93%) had a new onset of stroke. After fully adjusting for confounding factors, for per 1-standard-deviation increment in AIP, the risk of stroke increased by 21% (HR＝1.1,5%CI:1.09～1.33, P＜0.001). Similarly, higher levels of AIP-WHtR (HR＝1.0,5%CI:1.18～1.66, P＜0.001) and AIP-BRI (HR＝1.4,5%CI:1.02～1.06, P＜0.001) were positively correlated with increased risk of stroke. Restrictive cubic spline analysis showed a positive dose-response relationship between AIP and its anthropometric-derived indicators AIP-WHtR, AIP-BRI and the risk of stroke, with a significant nonlinear trend. In addition, subgroup analysis further confirmed that higher AIP levels were associated with an increased risk of stroke in males (HR＝1.5,5%CI:1.08～1.44, P＜0.001), whereas the association was not significant in females (HR＝1.5,5%CI:1.00～1.32, P＝0.050). Conclusion In the middle-aged and elderly population, higher levels of AIP and its anthropometric-derived indicators AIP-WHtR and AIP-BRI are positively correlated with increased risk of stroke, and these indicators may serve as effective risk of stroke assessment tools.