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目的 探讨心脏代谢指数（cardiometabolic index,CMI）与中老年人心肌梗死的关系。方法 数据资料来源于美国国家健康与营养调查数据库（2011～2018年），选取5132例45岁及以上患者进行横断面调查研究。收集人口统计学变量、社会经济地位、健康行为和健康状况等临床资料，根据是否发生心肌梗死将患者分为非心肌梗死组和心肌梗死组。比较两组患者的基线资料，运用加权Logistic回归模型评估CMI与心肌梗死的关系。将CMI作为连续变量并按照四分位数进行分析。针对潜在协变量进行亚组分析和中介分析，进一步探讨协变量对CMI与心肌梗死关系的修饰作用和间接效应。将缺失数据通过多重插补法进行处理。结果 5132例患者中，335例发生心肌梗死（6.53%）。心肌梗死组的CMI值显著高于非心肌梗死组（0.61 vs. 0.52,P<0.001）。Logistic回归分析结果显示，CMI每增加一个单位，则心肌梗死的发生风险增加16.00%(OR=1.16,95%CI:1.03～1.32,P=0.015)。将CMI按照四分位数进行分析，结果显示第三和第四分位数的患者较最低四分位数患者的心肌梗死发生风险显著增加。经亚组分析后结果显示，男性、非西班牙裔白色人种、已婚或与伴侣同住者、教育水平高于高中以上、贫困收入比≥3.50、戒烟、戒酒、糖尿病、无高血压、高胆固醇血症、体质指数（BMI）≥30 kg/m2、中心性肥胖、睡眠时间<6 h者及无体力活动者中，CMI与心肌梗死之间存在显著关联。中介分析结果表明，吸烟、睡眠时间、贫困收入比、高血压、高胆固醇血症、性别、种族、糖尿病、中心性肥胖、体质指数（BMI）以及年龄对CMI与心肌梗死的关系有显著的间接效应，而与吸烟、贫困收入比、高血压、性别和年龄有直接效应。结论 CMI升高与中老年人心肌梗死患病风险呈正相关，CMI对预测中老年人群心肌梗死发生具有重要价值。
Abstract：Objective To discuss the relationship between cardiometabolic index(CMI) and myocardial infarction(MI) in elderly population. Methods The data were derived from the database of the National Health and Nutrition Examination Survey(NHANES, 2011～2018). A cross-sectional study was conducted involving 5132 patients aged 45 years and above. Clinical data such as demographic variables, socioeconomic status, health behaviors, and health status were collected. Patients were divided into non-MI group and MI group based on whether they had experienced MI. The baseline data were compared between 2 groups, and correlation between CMI and MI was assessed by using weighted Logistic regression model with CMI as a continuous variable based on quartiles. Subgroup analysis and mediation analysis were performed on potential covariates to further explore the modifying effect and indirect effect of covariates on the relationship between CMI and MI. Missing data were handled by using multiple imputation. Results Of the 5132 patients, 335 had MI, with an incidence rate of 6.53%. The CMI value in MI group was significantly higher than that in non-MI group(0.61 vs. 0.52, P<0.001). The results of Logistic regression analysis showed that for each unit increase in CMI, MI risk increased by 16.00%(OR=1.16, 95%CI: 1.03～1.32, P=0.015). CMI was analyzed by quartiles, and the results showed that patients in the third and fourth quartiles had a significantly increased MI risk compared with those in the lowest quartile. Subgroup analysis revealed a significant correlation between CMI and MI in males, non-Hispanic whites, those who were married or living with a partner, those with an educational level above high school, those with a poverty income ratio≥3.50, former smokers, former drinkers, diabetic patients, those without hypertension, patients with hypercholesterolemia, those with a body mass index(BMI)≥30 kg/m2, those with central obesity, those with a sleep duration<6 hours, and those without physical activity. The results of mediation analysis indicated that smoking, sleep duration, poverty-income ratio, hypertension, hypercholesterolemia, gender, race, diabetes, central obesity, BMI, and age had significant indirect effects on the relationship between CMI and MI, while smoking, poverty-income ratio, hypertension, gender, and age had direct effects on this relationship. Conclusion Elevated CMI is positively correlated to MI risk in middle-aged and older adults, and CMI is valuable for predicting MI occurrence in this population.
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基本信息:
中图分类号:R542.22
引用信息:
[1]陈鹏,白静,李华清,等.心脏代谢指数与心肌梗死关系的横断面研究[J].中国循证心血管医学杂志,2025,17(11):1293-1299.
2025-11-20
2025-11-20