| The first part:Relationship of lipid accumulation product with hypertension and diabetes among Beijing adults:a Cross-sectional studyBackgroundA considerable number of researchers have recognized that adipose tissue has complex functions,and these functions may vary in different anatomic sites.Some adipose tissue from specific region have beneficial effects,such as daily energy storage and buffering.However,excessive accumulation of the other adipose tissue is specifically associated with insulin resistance,nonalcoholic fatty liver disease,metabolic syndrome and so on.To measure these harmful lipid accumulation,some researchers proposed a comprehensive index based on waist circumference and fasting triglyceride concentration.The aim of this study is to define the lipid accumulation product(LAP)formula for Beijing adults and to explore the relationship between lipid accumulation product and hypertension,as well as diabetes.MethodsA total of 19606 residents including 8869 males and 10737 females aged 18-79 years from the Beijing Chronic Disease Survey 2011 were analyzed in this study.A multiple stage,random cluster sampling method was used to select the study subjects.The sex-specific hypothetical minimum waist circumference(WC)was calculated in order to obtain the more applicable LAP formula.A ROC analysis was performed to compare the ability of LAP and BMI in screening for hypertension and diabetes.Multivariate logistic regression was used to evaluate the associations of LAP and body mass index(BMI)with hypertension and diabetes.ResultsThe LAP formula for Beijing adults was established as follows:LAP(men)=(WC-61.3)x TG,and LAP(women)=(WC-55.6)x TG.The values of area under the ROC curve(AUC)of LAP for predicting diabetes in males,as well as hypertension and diabetes in females were all greater than 0.59,and significantly higher than those of BMI(P<0.001).There was an obvious trend of increased risk of hypertension and diabetes with an increment in the tertiles of the LAP both in men and women.The odds ratio(OR)for hypertension in the group with highest LAP was 3.62(95%CI,3.11,4.22)in men and 5.79(4.84,6.93)in women,compared with the lowest tertile group,respectively;and the corresponding OR for diabetes was 3.47(2.73,4.41)in men and 4.10(2.90,5.80)in women,respectively.Compared with the lowest tertile of LAP and normal BMI group,the OR for hypertension in the highest tertile of LAP and obesity group was 6.79(5.50,8.37)in men and 9.75(7.76,12.25)in women,respectively;while the corresponding value for diabetes was 3.97(2.87,5.49)in men and 4.13(2.78,6.14)in women,respectively.ConclusionThe elevated level of LAP was associated with an increased risk of hypertension and diabetes among Beijing adults.LAP could be an important predictor for hypertension and diabetes.The second part:The association between lipid accumulation product and the incidence of Atherosclerotic Cardiovascular Disease in Chinese adults:a prospective cohort studyBackgroundSome prospective cohort studies have reported that high lipid accumulation product(LAP)level increase the risk of incident diabetes and stroke.However,all of these studies used the same LAP formula proposed by Kahn,which was based on the data from American population,and may not necessarily applicable for other populations.The purpose of this study was to put forward the LAP formula suitable for Chinese adults using 2000 Chinese Health and Nutrition Survey data,and to examine the association between LAP level and incident atherosclerotic cardiovascular disease through the long term prospective cohort study.MethodsThe data from 2000 China Health and Nutrition Survey was used to calculate the LAP formula of Chinese population.Whereafter,the study participants were from two cohorts:China Multicenter Collaborative Study of Cardiovascular Epidemiology and China Cardiovascular Health Study,which started in 1998 and 2000-2001,respectively.,involving a total of 27020 participants aged between 35 and 74 years.The two follow-up survey was conducted in 2007-2008 and 2013-2015.The final analysis included 23227 participants with 11112 men and 12115 women.The subjects were divided into 4 groups by quartiles of LAP by gender.Cox proportional hazards regression model was used to evaluate hazard ratios(HRs)with 95%confidence interval(95%CIs)for incident atherosclerotic cardiovascular disease(ASCVD)due to different LAP levels.ResultsThe LAP formula for Chinese adults was established as follows:LAP(men)=(WC-59.1)× TG,and LAP(women)=(WC-56.4)× TG.During 12.3 years of follow-up,1081 participants(657 in men and 424 in women)developed ASCVD.The incidence of atherosclerotic cardiovascular disease across increasing LAP level groups were 3.74/1000 person-years,4.18/1000 person-years,5.71/1000 person-years and 5.98/1000 person-years in men,the corresponding number were 1.25/1000 person-years,2.21/1000 person-years,2.82/1000 person-years and 5.12/1000 person-years in women,respectively.After adjusting for age,geographic region,urbanization,educational level,current smoking,alcohol use,physical activity,fasting blood glucose,baseline systolic blood pressure and family history of cardiovascular disease,using the first quartile of LAP as reference group,the hazard ratios(95%CIs)for atherosclerotic cardiovascular disease in the second quartile LAP group,third quartile LAP group and fourth quartile LAP group was 0.97(0.76,1.25),1.17(0.92,1.49)and 1.10(0.85,1.41)in men,respectively,P for trend =0.407,and the corresponding results for women was 1.42(0.98,2.06),1.30(0.90,1.87)and 1.72(1.21,2.44),separately,P for trend =0.003.Using the log-transformed LAP as a continuous variable into the Cox regression model,each unit of Lnlap addition was associated with a 24%(95%CI:8.9%,41.2%)increase in risk of incident atherosclerotic cardiovascular disease in women,while it was 5.3%increase in men with no statistical significance.ConclusionsHigher LAP level had an significantly increased risk of developing atherosclerotic cardiovascular disease in women,but disagree with it in men.Our findings suggest that LAP is a risk factor and has a predictive value for ASCVD in women.Further studies are needed to confirm our result observed in men. |
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