基于STEPP的健康膳食模式与心血管事件风险关联的异质性分析  

Heterogeneity analysis of the association between healthy dietary patterns and cardiovascular event risk based on

作　　者：王威 梁君雅 于茜 胡馨茹 杨凡 王晓骁 STEPP WANG Wei;LIANG Junya;YU Qian;HU Xinru;YANG Fan;WANG Xiaoxiao(GCP Center,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China;Hypertension Institute,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China;Department of Science and Technology,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China;Department of Public Health,School of Medicine&Holistic Integrative Medicine,Nanjing University of Chinese Medicine,Nanjing 210046,China;School of Public Health,Nanjing Medical University,Nanjing 211166,China;Clinical Research Institute,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院GCP中心,江苏南京210029 [2]南京中医药大学附属医院高血压研究所,江苏南京210029 [3]南京中医药大学附属医院科技处,江苏南京210029 [4]南京中医药大学医学院·整合医学学院公共卫生学系,江苏南京210046 [5]南京医科大学公共卫生学院,江苏南京211166 [6]南京中医药大学附属医院中医临床研究院,江苏南京210029

出　　处：《现代医学》2024年第8期1233-1241,共9页Modern Medical Journal

基　　金：2023年度江苏省预防医学科研课题(Ym2023103);江苏省卫健委医学科研项目(M2021001);南京中医药大学自然科学基金资助项目(XZR2021005);2022年度科主任学术提升专项课题(Y2022ZR14)。

摘　　要：目的:分析不同受试者亚群中健康膳食模式(地中海膳食与低脂膳食)与心血管事件风险的关联及异质性,探究地中海膳食预防心血管事件的最佳亚群。方法:对西班牙PREDIMED试验数据进行二次分析,分别以肥胖指标:身体质量指数(BMI)、腰围(WC)、腰围身高比(WHtR)和身高校正腰围指数(HWI)为划分研究对象亚群的协变量,采用亚群治疗效果模式图(STEPP)探索健康膳食模式与心血管事件风险关联在不同亚群间的异质性。结果:在STEPP分析中,以风险比(HR)为效应指标时,亚群间的异质性有统计学意义。当研究对象的BMI在27.69-51.94 kg·m^(-2)、WC在100~177 cm、WHtR在0.61~1.00和HWI在7.89~13.30之间时,低脂膳食组发生心血管事件的风险高于地中海饮食组,关联有统计学意义。结论:在以肥胖指标划分的亚群中,不同膳食模式与心血管事件风险的关联具有异质性;在高心血管事件风险人群中,对于肥胖指标较高者,地中海膳食模式更有益于降低心血管事件的发生风险。Objective:To analyze the association and heterogeneity between healthy dietary patterns(Mediterranean diet and low-fat diet)and cardiovascular event risk in different subpopulation of participants,exploring the optimal subpopulation that benefit most from the preventive effects of the Mediterranean diet on cardiovascular events.Methods:Secondary analysis was conducted using data from the Spanish PREDIMED trial.Subpopulation treatment effect pattern plots(STEPP)were used to explore heterogeneity of the association between healthy dietary patterns and cardiovascular event risk among different subpopulations,with obesity indicators such as body mass index(BMI),waist circumference(WC),waist-to-height ratio(WHtR),and height-adjusted waist circumference indices(HWI)as covariates for subpopulation stratification.Results:In STEPP analysis,when hazard ratio(HR)was used as the effect index,the heterogeneity among subpopulations was statistically significant.The risk of cardiovascular events in the low-fat diet group was higher than that in the Mediterranean diet group when the BMI was 27.69-51.94 kg·m^(-2),WC was 100-177 cm,WHtR was 0.61-1.00 and HWI was 7.89-13.30,and the association was statistically significant.Conclusion:The association between dietary patterns and the risk of cardiovascular events was heterogeneous among the subpopulations splitting by obesity indicators.Among people with high cadiovascular events risk,the Mediterranean diet pattern is more beneficial to reduce the risk of cardiovascular events for those with higher obesity indicators.

关 键 词：膳食模式 心血管事件 亚群治疗效果模式图 肥胖指标 异质性分析 

分 类 号：R181[医药卫生—流行病学]