The Effect of Lipid Accumulation Product and Its Interaction With Family History of Hypertension on Hypertension Risk in Population With Nondiabetic in Eastern China: A Cross-sectional Study

Abstract Background: Lipid Accumulation Product (LAP) was proposed as a useful indicator of visceral obesity, the visceral obesity and cardiovascular diseases are closely related. However, the empirical evidences of LAP and hypertension (HTN) are limited. Our study sought to assess the risk factors of HTN and prehypertension (PHT), and provide an insight into the possible interacting influences of LAP with family history of HTN on the risk of HTN in the nondiabetic Eastern Chinese population. Methods: A large cross-sectional study was conducted in community health service centers in urban Bengbu of Anhui province, China. All elderly person aged 45 years and older were performed an interview questionnaire, physical measurements and biochemical indicators examinations by trained staffs. Common indexes to screen obese persons such as body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and LAP were calculated. Multivariate logistic regression was used to test the prevalence of HTN and PHT in relation to each quartile increase in LAP level and family history of HTN. The receiver operating characteristic (ROC) analysis was applied to calculate the best cut-off value of LAP and identify the superior obesity indicator. The interaction effects were evaluated by relative excess risk of interaction (RERI), attributable proportion due to interaction (AP) and synergy index (SI). Results: 7733 subjects were enrolled in our study, the overall prevalence rates of normotension, PHT and HTN were 38.1%, 37.1% and 24.8%, respectively. The prevalence of HTN increased rapidly across LAP quartiles in males and females, the LAP values in the top quartile were significantly higher than those in the bottom quartile (31.8% vs. 17.6% in males, p for trend <0.001; 31.4% vs. 18.8% in females, p for trend <0.001). The AUC value of LAP were superior to BMI in males (Z=6.627, p<0.001) and females (Z=8.045, p<0.001). Multinomial logistic regression analysis showed that compared with subjects in LAP quartile 1, those in quartile 3 (OR: 1.612, 95% CI: 1.386-1.876) and quartile 4 (OR: 1.942, 95% CI: 1.673-2.253) had significantly higher risk of HTN (p for trend<0.001) after adjusting for confounding factors. A significant interaction was observed between LAP and family history of HTN in males (AP: 0.1663, 95% CI: 0.0027-0.3299; SI: 1.4035, 95% CI: 1.0597-1.8590) and females (RERI: 1.4109, 95% CI: 0.1455-2.9674; AP: 0.1664, 95% CI: 0.0088-0.3240; SI: 1.3884, 95% CI: 1.0565-1.8245). Conclusion: LAP is a simple and convenient index to predict the HTN risk, higher LAP values have relatively associated with higher blood pressure (BP). The results demonstrated that interactive effects of LAP with family history of HTN may synergistically influence the development of HTN.