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中国全科医学

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相对脂肪量与中老年人群心血管疾病之间的关联：一项基于CHARLS的横断面与纵向研究

陈慧龙1，廖芸楚1，刘育伟1，孔政辉1，黄兴辉2，徐嘉辉2，漆娜2，王远平2，梁文坚2*   

  1. 广州中医药大学第五临床医学院
    广东省第二中医院
  • 收稿日期:2025-04-02 接受日期:2025-04-08
  • 通讯作者: 梁文坚
  • 基金资助:
    国家自然科学基金-青年科学基金项目(82405259); 广东省基础与应用基础研究基金项目(2022A1515220151); 广东省中医药局科研项目(20241015)

Association between relative fat mass and cardiovascular disease in middle-aged and older adults: a cross-sectional and longitudinal study based on CHARLS

  • Received:2025-04-02 Accepted:2025-04-08
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摘要： 目的 利用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）数据，分析中国人相对脂肪量 ( relative fat mass，RFM)与中老年人群（≥45岁）心血管疾病（Cardiovascular Disease，CVD）发病风险的关系。方法 采用多因素Logistic回归和限制性立方样条(RCS)分析RFM与CVD之间的横断面关联。采用Kaplan-Meier曲线、多因素COX比例风险回归模型和RCS分析2011年不同的基线RFM水平与新发CVD风险之间的纵向关联，并采用亚组分析探讨评估不同亚组相关性的一致，采用敏感性分析验证模型的稳定性。结果 横断面研究共纳入12867名中老年人进行分析，平均年龄（59.49±9.61）岁。其中男性4117人（47.54%），女性6750人（52.46%）。完全调整后的模型显示，RFM与CVD风险呈正相关（OR＝1.03，95% CI 1.02～1.04）。与第一个四分位数（Q1）组相比，Q2（OR＝1.26，95% CI 1.07～1.49）、Q3（OR＝1.78，95% CI 1.47～2.16）和 Q4（OR＝1.81，95% CI 1.49～2.19）组中老年人具有更高的CVD风险。纵向研究纳入了11171位2011年横断面研究中无CVD的中老年人，在随访期间，共1655人(14.9%)首次被诊断为CVD。完全调整后的模型显示，与Q1相比，Q2（HR＝1.31，95% CI 1.12～1.52）、Q3（HR＝1.34，95% CI 1.12～1.61）和Q4（HR＝1.79，95% CI 1.49～2.14）组的新发CVD风险均显著高于Q1组。此外，亚组分析显示，RFM与婚姻情况具有交互作用，敏感性分析结果与以上主要研究结果趋势一致。结论 较高水平的RFM与CVD发病风险增加有关，提示RFM可能在CVD预防和治疗中具有潜在价值。

关键词: 中国健康与养老追踪调查, 相对脂肪量, 心血管疾病, 中老年人, 队列研究

Abstract: Objective The relationship between relative fat mass (RFM) and the risk of cardiovascular disease (CVD) in middle-aged and elderly people (≥ 45 years) in China was analyzed using data from the China Health and Retirement Longitudinal Study (CHARLS).Methods Multivariate logistic regression and restricted cubic splines (RCS) were used to analyze the cross-sectional association between RFM and CVD. Kaplan-Meier curves, multivariate Cox proportional hazards regression models, and RCS were used to analyze the longitudinal association between different baseline RFM levels and incident CVD risk in 2011, subgroup analysis was used to investigate the consistency of assessing the association between different subgroups, and sensitivity analysis was used to verify the stability of the model.Results A total of 12,867 middle-aged and elderly people with a mean age of (59.49 ± 9.61) years were included in the cross-sectional study for analysis.Of these, 4117 (47.54%) were male and 6750 (52.46%) were female.The fully adjusted model showed that RFM was positively associated with CVD risk (OR = 1.03, 95% CI 1.02 to 1.04).Middle-aged and older adults in Q2 (OR = 1.26, 95% CI 1.07 to 1.49), Q3 (OR = 1.78, 95% CI 1.47 to 2.16), and Q4 (OR = 1.81, 95% CI 1.49 to 2.19) groups had a higher risk of CVD compared with the first quartile (Q1) group.The longitudinal study included 11,171 middle-aged and older adults without CVD in a 2011 cross-sectional study, and a total of 1655 (14.9%) were first diagnosed with CVD during follow-up.The fully adjusted model showed a significantly higher risk of new CVD in Q2 (HR = 1.31, 95% CI 1.12 to 1.52), Q3 (HR = 1.34, 95% CI 1.12 to 1.61), and Q4 (HR = 1.79, 95% CI 1.49 to 2.14) groups compared with Q1.In addition, subgroup analysis showed that RFM interacted with marital status, and the sensitivity analysis results were consistent with the trends of the above main study results.Conclusion Higher levels of RFM are associated with an increased risk of CVD, suggesting that RFM may be of potential value in CVD prevention and treatment.

Key words: China health and retirement longitudinal study, relative fat mass, cardiovascular disease, middle-aged and elderly people, cohort study

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