代謝健康狀態與體重對於老年人心血管事件及死亡率的影響：具台灣代表性的世代研究

The Influences of Metabolic Health Status and Body Weight on Cardiovascular Events and All-cause Mortality in the Elderly: a Representative Cohort Study in Taiwan

陳信豪(Hsin-Hao Chen) ； 蔡思盈(Sz-Ying Tsai) ； 黃秀梨(Hsiu-Li Huang)

《台灣老年醫學暨老年學會雜誌》 17卷1期 (2022/02) Pp. 46-59

https://doi.org/10.29461/TGGa.202202_17(1).0004

摘要

目的：本研究的目的是探討代謝健康狀態與體重過重與否對於台灣長者心血管事件及全死因死亡風險的影響。方法：我們從台灣三高資料庫（Taiwanese survey on hypertension, hyperglycemia, and hyperlipidemia, TwSHHH）中收集2002年的資料，扣除體重過輕及資料不完全者，共650位長者追蹤至2015年，我們定義身體質量指數（BMI） ≥24 kg/m^2為過重／肥胖，定義代謝健康為首先必須不具有高血壓、高血脂或糖尿病，且必須符合健康的心血管代謝（cardiometabolic）標準，包含收縮壓（SBP） ＜130 mmHg且舒張壓（DBP） ＜85 mmHg，空腹血糖＜100 mg/dL，三酸甘油酯（TG） ＜150mg/dL，高密度酯蛋白膽固醇（HDL）男性＞40 mg/d或女性＞50 mg/ dL。我們以代謝健康且正常體重（metabolically healthy normal weight, MHNW）為對照組，利用Cox比例風險模型計算不同的BMI及代謝是否健康分組下，其心血管事件及全死因死亡之複合事件風險（composite events）。結果：我們總共追蹤6,191.9人年間發生381個複合事件，其中代謝健康但體重過重／肥胖（metabolically healthy overweight / obese, MHOO）長者其發生複合事件之風險無顯著升高（HR: 1.42, 95%CI: 0.79, 2.56），但代謝不健康且體重過重／肥胖（metabolically unhealthy obesity/overweight, MUOO）者其風險顯著較高（HR: 1.57, 95%CI: 1.06, 2.32），其次為代謝不健康但體重正常者（metabolically unhealthy normal weight, MUNW）（HR: 1.46, 95%CI: 0.98, 2.15）；數種敏感度分析也呈現類似結果。結論：MUOO長者其發生心血管事件及全死因死亡之複合事件風險相較於MHNW長者有顯著升高，其次為MUNW者，而MHOO長者風險並無顯著升高，所以體重過重／肥胖長者應優先致力於改善代謝健康狀態，另外體重正常但代謝不健康的長者也須注意其健康風險。

關鍵字

代謝健康 ； 體重 ； 老人 ； 心血管事件 ； 全死因死亡

並列摘要

Objective: The objective of this study is to investigate the impacts of metabolic health status and body weight on cardiovascular events (CVE) and all-cause mortality (ACM) in the elderly in Taiwan. Methods: A total of 650 elderly people from the cohort of 2002~2015 Taiwanese Survey on the Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH) were included after excluding those marked with underweight or missing data. Overweight or obesity was defined as BMI ≥24 kg/m^2 and metabolic health defined as absence of hypertension, diabetes or hyperlipidemia with healthy cardiometabolic indicators (SBP ＜130 mmHg and DBP ＜85 mmHg, AC ＜100 mg/dL, triglyceride ＜150 mg/dL, HDL ＞40 mg/dL in man or ＞50 mg/dL in woman). We used the Cox proportional hazards regression models to explore the relationship between baseline BMI-metabolic groups and composite events (CVE and ACM) with metabolically healthy normal weight (MHNW) elderly people as a reference. Results: A total of 381 events were observed over 6191.9 person-years of follow-up. Metabolically healthy overweight/obese (metabolically unhealthy obesity/ overweight, MUOO) elderly people were not at increased risk of composite events when compared to their MHNW counterparts (HR: 1.42, 95% CI: 0.79~2.56) after adjusting covariates. However, metabolically unhealthy overweight/obese (MUOO) elderly people did appear to be at a significantly elevated risk of composite events (HR: 1.57, 95% CI: 1.06~2.32), and so did metabolically unhealthy normal weight (MUNW) elderly people (HR: 1.46, 95% CI: 0.98~2.15). A sensitivity analysis was conducted and showed similar results. Conclusion: MUOO elderly people were associated with increased CVE and ACM, followed by MUNW ones. MHOO elderly people were at no elevated risk compared with their MHNW counterparts. Overweight/obese elderly people should make improving their metabolic health a top priority, while MUNW elderly people also need to pay attention to manage their health risks.

並列關鍵字

metabolic health ； body weight ； elderly ； cardiovascular events ； all-cause mortality