Clusters of Cardiometabolic Risk Factors and Their Association with Atherosclerosis and Chronic Inflammation among Adults and Elderly in Florianópolis, Southern Brazil

Abstract Background The significant increase in cardiovascular diseases in developing countries alerts about their impact on underprivileged populations. Objective To identify the relationship of clusters of metabolic syndrome (MS) components with atherosclerosis and chronic inflammation among adults and elderly. Methods Cross-sectional analysis using data from two population-based cohort studies in Florianópolis, Southern Brazil (EpiFloripa Adult Cohort Study, n = 862, 39.9±11.5 years; EpiFloripa Aging Cohort Study, n = 1197, 69.7±7.1 years). Blood pressure (BP), waist circumference (WC), and lipid and glucose levels were analyzed as individual factors or as clusters (either as the number of components present in an individual or as combinations of components). Outcomes included carotid intima-media thickness (IMT), atherosclerotic plaques, and C-reactive protein (CRP) levels. Multiple linear and logistic regression analyses adjusted for confounding factors were used. The statistical significance adopted was 5%. Results Individuals with high BP, elevated WC, dyslipidemia and hyperglycemia (6.1% of the sample) showed higher IMT and CRP than those negatives for all MetS components. Elevated WC was a common determinant of systemic inflammation, while the coexistence of high BP and elevated WC (clusters of two or three factors) was associated with higher IMT (β between +3.2 and +6.1 x 10-2 mm; p value < 0.05) and CRP (EXPβ between 2.18 and 2.77; p value < 0.05). Conclusion The coexistence of high BP and elevated WC was associated with increased IMT and CRP levels, but central obesity affected systemic inflammation either alone or in combination with other risk factors.

【摘要】
背景：发展中国家心血管疾病的显著增加，警示其对弱势群体的健康影响。
研究目的：明确成人及老年人群中代谢综合征（metabolic syndrome, MS）组分聚类与动脉粥样硬化及慢性炎症的关联。
研究方法：采用巴西南部弗洛里亚诺波利斯两项基于人群的队列研究数据开展横断面分析：埃皮弗洛里帕成人队列研究（EpiFloripa Adult Cohort Study，n=862，年龄39.9±11.5岁）；埃皮弗洛里帕老年队列研究（EpiFloripa Aging Cohort Study，n=1197，年龄69.7±7.1岁）。将血压（blood pressure, BP）、腰围（waist circumference, WC）、血脂及血糖水平作为单个因素或聚类组合（以个体具备的组分数量或组分联合形式进行分析）。结局指标包括颈动脉内膜中层厚度（carotid intima-media thickness, IMT）、动脉粥样硬化斑块及C反应蛋白（C-reactive protein, CRP）水平。采用校正混杂因素的多重线性回归与logistic回归分析，检验水准设定为5%。
研究结果：同时合并高血压、腰围升高、血脂异常及高血糖的个体（占总样本的6.1%），其颈动脉内膜中层厚度及C反应蛋白水平均高于所有代谢综合征组分均为阴性的个体。腰围升高是全身炎症的常见危险因素；而高血压与腰围升高共存（2或3个危险因素的聚类组合）与更高的颈动脉内膜中层厚度（β值为+3.2~+6.1×10^-2 mm；P<0.05）及C反应蛋白水平（比值比EXPβ为2.18~2.77；P<0.05）相关。
研究结论：高血压与腰围升高共存与颈动脉内膜中层厚度及C反应蛋白水平升高相关，但中心性肥胖无论单独存在还是与其他危险因素联合，均可影响全身炎症状态。