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Risk Classification for Metabolic Syndrome and the Incidence of Cardiovascular Disease in Japan With Low Prevalence of Obesity: A Pooled Analysis of 10 Prospective Cohort Studies
Journal of the American Heart Association ( IF 5.4 ) Pub Date : 2021-11-19 , DOI: 10.1161/jaha.121.020760
Hiroyasu Iso 1 , Renzhe Cui 1 , Iseki Takamoto 2, 3 , Masahiko Kiyama 4 , Isao Saito 5 , Tomonori Okamura 6 , Yoshihiro Miyamoto 7 , Aya Higashiyama 7 , Yutaka Kiyohara 8, 9 , Toshiharu Ninomiya 9 , Michiko Yamada 10 , Hideaki Nakagawa 11 , Masaru Sakurai 11 , Michio Shimabukuro 12 , Moritake Higa 13 , Kazuaki Shimamoto 14 , Shigeyuki Saito 14 , Makoto Daimon 15, 16 , Takamasa Kayama 17 , Mitsuhiko Noda 3 , Sadayoshi Ito 18 , Koutaro Yokote 19 , Chikako Ito 20 , Kazuwa Nakao 21 , Toshimasa Yamauchi 2 , Takashi Kadowaki 2, 22
Affiliation  

BackgroundIt is uncertain whether risk classification under the nationwide program on screening and lifestyle modification for metabolic syndrome captures well high‐risk individuals who could benefit from lifestyle interventions. We examined the validity of risk classification by linking the incidence of cardiovascular disease (CVD).Methods and ResultsIndividual‐level data of 29 288 Japanese individuals aged 40 to 74 years without a history of CVD from 10 prospective cohort studies were used. Metabolic syndrome was defined as the presence of high abdominal obesity and/or overweight plus risk factors such as high blood pressure, high triglyceride or low high‐density lipoprotein cholesterol levels, and high blood glucose levels. The risk categories for lifestyle intervention were information supply only, motivation‐support intervention, and intensive support intervention. Sex‐ and age‐specific hazard ratios and population attributable fractions of CVD, which were also further adjusted to consider non–high density lipoprotein cholesterol levels, were estimated with reference to nonobese/overweight individuals, using Cox proportional hazard regression. Since the reference category included those with risk factors, we set a supernormal group (nonobese/overweight with no risk factor) as another reference. We documented 1023 incident CVD cases (565 men and 458 women). The adjusted CVD risk was 60% to 70% higher in men and women aged 40 to 64 years receiving an intensive support intervention, and 30% higher in women aged 65 to 74 years receiving a motivation‐support intervention, compared with nonobese/overweight individuals. The population attributable fractions in men and women aged 40 to 64 years receiving an intensive support intervention were 17.7% and 6.6%, respectively, while that in women aged 65 to 74 years receiving a motivation‐support intervention was 9.4%. Compared with the supernormal group, nonobese/overweight individuals with risk factors had similar hazard ratios and population attributable fractions as individuals with metabolic syndrome.ConclusionsSimilar CVD excess and attributable risks among individuals with metabolic syndrome components in the absence and presence of obesity/overweight imply the need for lifestyle modification in both high‐risk groups.

中文翻译:

日本肥胖率低的代谢综合征风险分类和心血管疾病发病率:10 项前瞻性队列研究的汇总分析

背景目前尚不确定全国范围内代谢综合征筛查和生活方式改变计划下的风险分类是否能很好地捕捉到可以从生活方式干预中受益的高风险个体。我们通过关联心血管疾病 (CVD) 的发病率来检验风险分类的有效性。方法和结果使用来自 10 项前瞻性队列研究的 29 288 名年龄在 40 至 74 岁且没有 CVD 病史的日本人的个体水平数据。代谢综合征被定义为存在高腹部肥胖和/或超重以及诸如高血压、高甘油三酯或低高密度脂蛋白胆固醇水平以及高血糖水平等风险因素。生活方式干预的风险类别为仅提供信息、动机支持干预、和密集的支持干预。使用 Cox 比例风险回归,参考非肥胖/超重个体估计了 CVD 的性别和年龄特定风险比和人群归因分数,也进一步调整以考虑非高密度脂蛋白胆固醇水平。由于参考类别包括那些有危险因素的人,我们设置了一个超常组(非肥胖/超重,没有危险因素)作为另一个参考。我们记录了 1023 例 CVD 病例(565 名男性和 458 名女性)。与非肥胖/超重个体相比,接受强化支持干预的 40 至 64 岁男性和女性的调整后 CVD 风险高 60% 至 70%,接受动机支持干预的 65 至 74 岁女性高 30% . 接受强化支持干预的 40 至 64 岁男性和女性的人口归因分数分别为 17.7% 和 6.6%,而接受激励支持干预的 65 至 74 岁女性的人口归因分数为 9.4%。与超常组相比,具有危险因素的非肥胖/超重个体与代谢综合征个体具有相似的风险比和人群归因分数。结论在不存在和存在肥胖/超重的情况下,具有代谢综合征成分的个体中相似的 CVD 过量和归因风险意味着两个高危人群都需要改变生活方式。
更新日期:2021-12-07
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