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-现代医学

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

单位：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

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

出版年·卷·期（页码）：2024·52·第八期（1233-1241）

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.

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