Kip Kevin E, Marroquin Oscar C, Kelley David E, Johnson B Delia, Kelsey Sheryl F, Shaw Leslee J, Rogers William J, Reis Steven E
Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA.
Circulation. 2004 Feb 17;109(6):706-13. doi: 10.1161/01.CIR.0000115514.44135.A8.
Obesity and the metabolic syndrome frequently coexist. Both are associated with cardiovascular disease (CVD). However, the contribution of obesity to cardiovascular risk, independent of the presence of the metabolic syndrome, remains controversial.
From the WISE study, 780 women referred for coronary angiography to evaluate suspected myocardial ischemia were classified by body mass index (BMI; <24.9=normal, n=184; > or =25.0 to < or =29.9=overweight, n=269; > or =30.0=obese, n=327) and presence (n=451) or absence (n=329) of the metabolic syndrome, further classified by diabetes status. Prevalence of significant angiographic coronary artery disease (CAD; > or =50% stenosis) and 3-year risk of CVD were compared by BMI and metabolic status. The metabolic syndrome and BMI were strongly associated, but only metabolic syndrome was associated with significant CAD. Similarly, unit increases in BMI (normal to overweight to obese) were not associated with 3-year risk of death (adjusted hazard ratio [HR] 0.92, 95% CI 0.59 to 1.51) or major adverse cardiovascular event (MACE: death, nonfatal myocardial infarction, stroke, congestive heart failure; adjusted HR 0.95, 95% CI 0.71 to 1.27), whereas metabolic status (normal to metabolic syndrome to diabetes) conferred an approximate 2-fold adjusted risk of death (HR 2.01, 95% CI 1.26 to 3.20) and MACE (HR 1.88, 95% CI 1.38 to 2.57). Levels of C-reactive protein (hs-CRP) were more strongly associated with metabolic syndrome than BMI but were not independently associated with 3-year risk of death or MACE.
The metabolic syndrome but not BMI predicts future cardiovascular risk in women. Although it remains prudent to recommend weight loss in overweight and obese women, control of all modifiable risk factors in both normal and overweight persons to prevent transition to the metabolic syndrome should be considered the ultimate goal.
肥胖与代谢综合征常常并存。二者均与心血管疾病（CVD）相关。然而，肥胖对心血管风险的影响，独立于代谢综合征之外，仍存在争议。
在WISE研究中，780名因疑似心肌缺血而接受冠状动脉造影的女性，根据体重指数（BMI；<24.9=正常，n=184；≥25.0至≤29.9=超重，n=269；≥30.0=肥胖，n=327）以及代谢综合征的存在与否（n=451或n=329）进行分类，并进一步根据糖尿病状态分类。通过BMI和代谢状态比较显著血管造影冠状动脉疾病（CAD；≥50%狭窄）的患病率以及3年心血管疾病风险。代谢综合征与BMI密切相关，但只有代谢综合征与显著CAD相关。同样，BMI单位增加（从正常到超重再到肥胖）与3年死亡风险（调整后风险比[HR]0.92，95%可信区间0.59至1.51）或主要不良心血管事件（MACE：死亡、非致命性心肌梗死、中风、充血性心力衰竭；调整后HR 0.95，95%可信区间0.71至1.27）无关，而代谢状态（从正常到代谢综合征再到糖尿病）使死亡风险（HR 2.01，95%可信区间1.26至3.20）和MACE风险（HR 1.88，95%可信区间1.38至2.57）增加约2倍。C反应蛋白（hs-CRP）水平与代谢综合征的关联比与BMI的关联更强，但与3年死亡风险或MACE无独立关联。
代谢综合征而非BMI可预测女性未来的心血管风险。尽管建议超重和肥胖女性减肥仍然是谨慎之举，但应将控制正常和超重人群中所有可改变的风险因素以防止转变为代谢综合征视为最终目标。
