Body size, insulin sensitivity, metabolic health and risk of cardiovascular disease in Chinese adults: Insights from the China Cardiometabolic Disease and Cancer Cohort (4C) study.
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Hu Chunyan, Wang Shuangyuan, Lin Hong, Wan Qin, Zheng Ruizhi, Zhu Yuanyue, Li Mian, Xu Yu, Xu Min, Zheng Jie, Chen Lulu, Zeng Tianshu, Hu Ruying, Ye Zhen, Shi Lixin, Su Qing, Chen Yuhong, Yu Xuefeng, Yan Li, Wang Tiange, Zhao Zhiyun, Qin Guijun, Chen Gang, Dai Meng, Zhang Di, Tang Xulei, Gao Zhengnan, Shen Feixia, Gu Xuejiang, Luo Zuojie, Qin Yingfen, Chen Li, Hou Xinguo, Huo Yanan, Li Qiang, Wang Guixia, Zhang Yinfei, Liu Chao, Wang Youmin, Wu Shengli, Yang Tao, Deng Huacong, Zhao Jiajun, Mu Yiming, Lai Shenghan, Li Donghui, Ning Guang, Wang Weiqing, Hu Weiguo, Bi Yufang, Lu Jieli, 4C Study Group
Аннотация
MATERIALS AND METHODS: We conducted a prospective study involving 115 638 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study. Metabolic health was defined using three different definitions: (1) insulin sensitivity defined by homeostatic model assessment of insulin resistance index; (2) absence of metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III criteria; and (3) simultaneous absence of metabolic abnormalities (diabetes, hypertension, dyslipidaemia). The primary endpoint was a composite of incident CVD events comprising the first occurrence of myocardial infarction, stroke, heart failure, or cardiovascular death.
RESULTS: During a mean 3.61-year follow-up period, obese individuals with insulin sensitivity (multivariable-adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.37-2.08), or without metabolic syndrome (HR 1.46, 95% CI 1.13-1.89) still exhibited increased CVD risks, when compared to their normal-weight counterparts. Otherwise, those with obesity but simultaneous absence of metabolic abnormalities demonstrated similar CVD risk compared to normal-weight individuals (HR 0.91, 95% CI 0.53-1.59). CVD risk increased with the number of abnormalities across body mass index categories, regardless of insulin sensitivity.
CONCLUSIONS: This study emphasizes the need for refined definitions of metabolic health and advocates for meticulous screening for metabolic abnormalities to reduce cardiovascular risks, even in individuals with normal weight and insulin sensitivity.