The Temporal Association Of Lipids With Obesity And The Effect Of Changes In Obesity With Dyslipidemia Participant On Essential Hypertension

Objective:To explore the effects of cumulative lipid exposure parameters and obesity on essential hypertension,and further analyze the temporal correlation between lipid and obesity,as well as the effects of changes in obesity on essential hypertension and cardiovascular risk factors in dyslipidemia,so as to provide theoretical basis for the prevention and treatment of essential hypertension.Methods:The subjects were enrolled in the longitudinal Study of Chronic Diseases in gannan,Jiangxi Province,which was established in 2017.The subjects were 35 to 65 years old.Follow-up surveys were completed in 2018,2019 and 2020,and physical examinations,questionnaires and biochemical indicators were conducted.New baseline participants are added each year.There were 4869 baseline subjects from 2017 to 2019.（1）Excluding baseline hypertensive participants,the study outcome was essential hypertension.A total of 1295participants were followed up from 2018 to 2020,with an average follow-up time of 2.98 years.Multiple linear regression model was used to investigate the association between diet and obesity and cumulative lipid burden.Cox proportional hazard model was used to evaluate the effect of cumulative lipid burden and obesity on essential hypertension.（2）Cross-hysteresis path analysis and mediation analysis were used to investigate the temporal causal association between blood lipid and Body mass index（BMI）and its influence on the incidence of essential hypertension.The study included 4786 baseline participants from 2017 to 2018 and 1251follow-up patients in 2020.（3）Cox proportional hazard regression was used to analyze the association between different obesity groups and essential hypertension and other cardiovascular risk factors in dyslipidemia.A total of 4,869 baseline participants were used during 2017-2019,excluding baseline participants with normal blood lipids and those with essential hypertension and Type 2 diebetes mellitus（T2DM）.A total of 724 subjects with dyslipidemia were followed up by 2020.Based on baseline and follow-up BMI measurements,obesity levels were divided into four groups:（1）continued normal:normal weight--normal weight;（2）continued abnormal:overweight or obese--overweight or obese;（3）reversed normal:overweight or obese--normal weight;and（4）abnormal outcome:normal weight--overweight orobese.Results:（1）A total of 240 essential hypertension patients occurred during the follow-up period,with an incidence density of 6.2/100 person-years.After multi-factor adjustment,compared withthe referencegroups,the risk of essential hypertension inthe accumulated Total cholesterol（TC）,triglycerides（TG）and High density lipoprotein（HDL）burden quartile increased by1.747 times（1.145-2.664）,1.502 times（1.038-2.173）and 0.615 times（0.413-0.917）,respectively.The risk of essential hypertension increased 1.914 times（1.244-2.945）for Waist height ratio（WHt R）and 1.803 times（1.195-2.722）for BMI quartile.The cumulative TG burden was positively correlated with BMI level（β=0.058,95%CI:0.008,0.107）.Red meat intake was positively correlated with cumulative TC（β=0.0010,95%CI:0.0001,0.0020）and refined grain intake was correlated with cumulative TC burden（β=-0.0010,95%CI:-0.0010,-0.0004）,vegetable intake was negatively correlated with cumulative LDL（β=-0.0003,95%CI:-0.0010,-0.0001）.（2）The cross-path lag analysis of lipid and obesity showed that TG and BMI influenced each other,but TG may change before BMI（TG→BMI path coefficient:ρ₁=0.141,P<0.001,BMI→TG path coefficient:ρ₂=0.054,P=0.018;ρ₁vsρ₂,P<0.001）.HDL and BMI affect each other,but HDL may change before BMI（HDL→BMI path coefficient:ρ₁=-0.222,P<0.001;BMI→HDL path coefficient:ρ₂=-0.053,P=0.011;ρ₁vsρ₂,P<0.001）.The effect of baseline TG on SBP is significantly mediated by BMI.βindirect=0.4113（95%CI:0.1883-0.7531）.The effect of baseline HDL on DBP is significantly mediated by BMI;βindirect=-1.1280（95%CI:-1.7832--0.5803）.（3）The changes of obesity in dyslipidemia on essential hypertension and its risk factors showed that the increase of blood pressure in the group with persistent abnormality was higher than that in the group with persistent normal,and the increase of TG in the group with outcome abnormality was higher than that in the group withpersistent normal.The risk ofessential hypertension,theproportion of substandard TG and the proportion of substandard HDL in the persistent abnormal group were 2.57（1.70-3.88）times,1.47（1.15-1.89）times and 2.59（1.34-5.00）times of those in the persistent normal group,respectively.In addition,the abnormal outcome group increased the risk of T2DM（HR=3.79,95%CI:1.06-13.47）.Compared with the persistent normal group,the reversal normal group had no significant effect on the risk of essential hypertension and diabetes and the proportion of unqualified blood lipids.Conclusion:（1）Cumulative TG burden,cumulative TC burden,BMI and WHt R increase the risk of essential hypertension,cumulative HDL burden reduces the risk of essential hypertension,and cumulative lipid burden is associated with obese diet.Blood lipid levels should be dynamically monitored to reduce the cumulative burden of TG and TC so as to prevent the occurrence of essential hypertension.（2）TG and HDL-C interact with BMI,and TG and HDLchange before BMI.There is a mediating effect of BMI in the process of TG affecting SBP,and a mediating effect of BMI in the process of HDL-C affecting DBP.（3）Abnormal changes in BMI of dyslipidemia（continuous increase of BMI and normal transition to overweight and obesity）can lead to increased risk of essential hypertension,T2DM and increased rate of dyslipidemia.Normalization of BMI in dyslipidemia is beneficial to the outcome of cardiovascular disease risk factors.