Abstract：Objective To explore the effect of different obesity indicators in predicting cardiovascular and cerebrovascular diseases (CVD) risk among patients with type 2 diabetes mellitus (T2DM), so as to provide the evidence for the early identification of CVD risk among T2DM patients. Methods The patients with T2DM under community management in Qingpu District, Shanghai Municipality were selected as the study subjects in January 2025. Basic information such as gender, age, and blood glucose control status were collected through the Shanghai Chronic Disease Information Management System, while history of CVD were obtained from residents' electronic health records and the Shanghai Disease Control Information Platform. Obesity was assessed using body mass index (BMI), waist circumference (WC), BMI combined with WC, waist-to-height ratio (WHtR), and triglyceride (TG) combined with WC indicators. The association between obesity and CVD was analyzed using multivariable logistic regression models. The predictive effect of each obesity indicators for CVD was evaluated using the area under the receiver operating characteristic curve (AUC). Results A total of 4 367 patients with T2DM were included, including 2 121 males (48.57%) and 2 246 females (51.43%). The average age was (68.71±8.05) years. The prevalence of CVD was 44.49%. Multivariable logistic regression analysis showed that after adjusting for age, education level, history of hypertension, duration of T2DM, use of glucose-lowering medications, renal function, and blood glucose control status, obese T2DM patients had a 389.4% increased risk of CVD compared to those with normal BMI; centrally obese T2DM patients had a 100.4% increased risk compared to those with normal WC; T2DM patients with isolated general obesity and compound obesity had 161.0% and 241.1% increased risks of CVD, respectively, compared to those with normal BMI and WC; centrally obese T2DM patients had a 100.4% increased risk compared to those with normal WHtR; T2DM patients with normal TG-high WC and high TG-high WC phenotypes had 83.1% and 68.8% increased risks of CVD, respectively, compared to those with normal TG and normal WC (all P<0.05). BMI had the highest AUC, at 0.714, with sensitivity and specificity of 0.675 and 0.642, respectively. This was followed by BMI combined with WC, which had an AUC of 0.707, with sensitivity and specificity of 0.635 and 0.679, respectively. Conclusions Obesity defined by BMI, WC, BMI combined with WC, WHtR, and TG combined with WC increases the risk of CVD among patients with T2DM. BMI and BMI combined with WC have better predictive effect in predicting CVD risk among patients with T2DM, and can be used as the primary obesity indicators for CVD risk screening.
陆杰, 张柯, 吴雅, 王玥, 张玥, 陆叶, 吴周理, 任志华, 黄艺文. 肥胖指标预测2型糖尿病患者心脑血管疾病的效果比较[J]. 预防医学, 2025, 37(9): 886-891.
LU Jie, ZHANG Ke, WU Ya, WANG Yue, ZHANG Yue, LU Ye, WU Zhouli, REN Zhihua, HUANG Yiwen. Comparison of the effect of obesity indicators in predicting cardiovascular and cerebrovascular diseases among patients with type 2 diabetes mellitus. Preventive Medicine, 2025, 37(9): 886-891.
[1] 中国心血管病风险评估和管理指南编写联合委员会.中国心血管病风险评估和管理指南[J].中国循环杂志,2019,34(1):4-28. The Joint Task Force for Guideline on the Assessment,Management of Cardiovascular Risk in China.Guideline on the assessment and management of cardiovascular risk in China[J].Chin Circ J,2019,34(1):4-28.(in Chinese) [2] 中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2022概要[J].中国循环杂志,2023,38(6):583-612. The Writing Committee of the Report on Cardiovascular Health and Diseases in China.Summary of Chinese cardiovascular health and diseases report 2022[J].Chin Circ J,2023,38(6):583-612.(in Chinese) [3] 《中国脑卒中防治报告2021》编写组.《中国脑卒中防治报告2021》概要[J].中国脑血管病杂志,2023,20(11):783-793. Report on Stroke Prevention Treatment in China Writing Group.Brief report on Stroke Prevention and Treatment in China,2021 [J].Chin J Cerebrovasc Dis,2023,20(11):783-793.(in Chinese) [4] 黄文,汤佳良,陈康康,等.绍兴市心血管疾病高危人群危险因素聚集分析[J].预防医学,2023,35(4):298-302,330. HUANG W,TANG J L,CHEN K K,et al.Clustering of risk factors among residents at high risk of cardiovascular diseases in Shaoxing City[J].China Prev Med J,2023,35(4):298-302,330.(in Chinese) [5] 贾铭,彭菊意,刘星宇,等.心血管代谢性共病危险因素的Meta分析[J].预防医学,2023,35(9):790-795. JIA M,PENG J Y,LIU X Y,et al.Risk factors for cardiometabolic multimorbidity:a meta-analysis[J].China Prev Med J,2023,35(9):790-795.(in Chinese) [6] 汪煜. 超重、肥胖和2型糖尿病与心脑血管疾病的关系——基于瑞典全国双生子人群的研究[D].天津:天津医科大学,2019. WANG Y.Association of overweight,obesity and type 2 diabetes with the risk of cardiocerebrovascular diseases:a nationwide Swedish twin study[D].Tianjin:Tianjin Medical University,2019.(in Chinese) [7] SHARMA A,LAVIE C J,BORER J S,et al.Meta-analysis of the relation of body mass index to all-cause and cardiovascular mortality and hospitalization in patients with chronic heart failure[J].Am J Cardiol,2015,115(10):1428-1434. [8] 中国血脂管理指南修订联合专家委员会.中国血脂管理指南(基层版 2024 年)[J].中国全科医学,2024,27(20):2429-2436. Joint Expert Committee on Revision of Chinese Blood Lipid Management Guidelines.Chinese guidelines for dyslipidemia management(primary care edition 2024)[J].Chin Gen Pract,2024,27(20):2429-2436.(in Chinese) [9] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版)[J].中华糖尿病杂志,2021,13(4):315-409. Chinese Diabetes Society of the Chinese Medical Association.Chinese clinical guidelines for type 2 diabetes prevention and treatment(2020 edition)[J].Chin J Diabetes Mellitus,2021,13(4):315-409.(in Chinese) [10] INKER L A,ENEANYA N D,CORESH J,et al.New creatinine-and cystatin C-based equations to estimate GFR without race[J].N Engl J Med,2021,385(19):1737-1749. [11] 中国肥胖问题工作组.中国成人超重和肥胖症预防与控制指南(节录)[J].营养学报,2004,26(1):1-4. Chinese Working Group on Obesity.Guidelines for prevention and control of overweight and obesity in Chinese adults (excerpt)[J].Acta Nutr Sin,2004,26(1):1-4.(in Chinese) [12] BROWNING L M,HSIEH S D,ASHWELL M.A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes:0.5 could be a suitable global boundary value[J].Nutr Res Rev,2010,23(2):247-269. [13] 刘丝雨. 吉林省成人高甘油三酯-腰围表型与心血管疾病关系研究[D].长春:吉林大学,2020. LIU S Y.Association between hypertriglyceridemic-waist phenotype and cardiovascular diseases in Jilin adults[D].Changchun:Jilin University,2020.(in Chinese) [14] HONG T P,YAN Z X,LI L,et al.The prevalence of cardiovascular disease in adults with type 2 diabetes in China:results from the cross-sectional CAPTURE study[J].Diabetes Ther,2022,13(5):969-981. [15] 王雨涵. 中老年2型糖尿病患者身体成分与心血管疾病的相关性研究[D].长春:吉林大学,2022. WANG Y H.Correlation between body composition and cardiovascular diseases in middle-aged and elderly patients with type 2 diabetes[D].Changchun:Jilin University,2022.(in Chinese) [16] 尹春宇,李亚鹏,赵笑颜,等.评估肥胖的四种指标与缺血性心脑血管病的关系[J].中华老年心脑血管病杂志,2020,22(5):487-492. YIN C Y,LI Y P,ZHAO X Y,et al.Evaluation of the relationship between 4 indexes of obesity and ischemic cardiocerebrovascular disease[J].Chin J Geriatr Heart Brain Vessel Dis,2020,22(5):487-492.(in Chinese) [17] 何佳,齐浩月,李毓,等.新疆哈萨克族农村居民不同肥胖程度和类型与心血管病发病关系[J].中国公共卫生,2022,38(3):297-301. HE J,QI H Y,LI Y,et al.Associations of different degrees and types of obesity with cardiovascular disease incidence among rural Kazakh residents in Xinjiang Uygur Autonomous Region[J].Chin J Public Health,2022,38(3):297-301.(in Chinese) [18] 马占莹,王洁蕊,宋海澄,等.正常体重中心性肥胖对新发心血管疾病和全因死亡的影响[J].中国循环杂志,2024,39(11):1110-1116. MA Z Y,WANG J R,SONG H C,et al.Association between normal-weight central obesity with new-onset cardiovascular disease and all-cause mortality[J].Chin Circ J,2024,39(11):1110-1116.(in Chinese) [19] LONARDO A,NASCIMBENI F,BALLESTRI S,et al.Sex differences in nonalcoholic fatty liver disease:state of the art and identification of research gaps[J].Hepatology,2019,70(4):1457-1469.
