肥胖与体力活动预测女性冠心病风险的比较

作     者：Rana J.S. Manson J.E. 刘宇 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第11期

页      面：43-44页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：女性冠心病 体力活动 非致死性 活动量 血管危险因素 心血管疾病 合并分析 腰臀比 相对风险 多变量 

摘      要：Background -The comparative importance of physical inactivity and obesity as predictors of coronary heart disease(CHD) risk remains unsettled. Methods and Results -We followed 88 393 women, 34 to 59 years of age, in the Nurses’Health Study from 1980 to 2000. These participants did not have cardiovascular disease and cancer at baseline. We documented 2358 incident major CHD events(including nonfatal myocardial infarction and fatal CHD) during 20 years of follow-up, including 889 cases of fatal CHD and 1469 cases of nonfatal myocardial infarction. In a multivariate model adjusting for cardiovascular risk factors, overweight and obesity were significantly associated with increased risk of CHD, whereas increasing levels of physical activity were associated with a graded reduction in CHD risk(P 0.001). In joint analyses of body mass index(BMI) and physical activity in women who had a healthy weight(BMI, 18.5 to 24.9 kg/m2) and were physically active(exercise ≥3.5 h/wk) as the reference group, the relative risks of CHD were 3.44(95%confidence interval[CI], 2.81 to 4.21) for women who were obese(BMI ≥30 kg/m2) and sedentary(exercise 1 h/wk), 2.48(95%CI, 1.84 to 3.34) for women who were active but obese, and 1.48(95%CI, 1.24 to 1.77)for women who had a healthy weight but were sedentary. In combined analyses of waist-hip ratio and physical activity, both waist-hip ratio and physical activity were significant predictors of CHD, and the highest risk was among women in the lowest category of physical activity and the highest tertile of waist-hip ratio(relative risk=3.03; 95%CI, 1.96 to 4.18). Even a modest weight gain(4 to 10 kg) during adulthood was associated with 27%(95%CI, 12%to 45%) increased risk of CHD compared with women with a stable weight after adjusting for physical activity and other cardiovascular risk factors. Conclusions -Obesity and physical inactivity independently contribute to the development of CHD in women. These data underscore the importance of both ma