Lopez-Jimenez Francisco, Jacobsen Steven J, Reeder Guy S, Weston Susan A, Meverden Ryan A, Roger Véronique L
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Chest. 2004 Apr;125(4):1205-12. doi: 10.1378/chest.125.4.1205.
To determine the trends in the prevalence of overweight and obese individuals among patients with myocardial infarction (MI), and to assess the association between weight and outcomes after MI.
Population-based cohort study.
MIs occurring in Olmsted County, MN, between 1979 and 1998 were validated using standardized criteria. Clinical characteristics and outcomes were ascertained from community medical records. The prevalence and trends of excess weight and its association with outcomes were analyzed.
Sixty-four percent of the 2,277 subjects with incident MI were overweight or obese. The prevalence of overweight/obese patients increased from 58% in the period from 1979 to 1983, to 72% in the period from 1994 to 1998 (p < 0.001), while the prevalence of class 3 obesity (body mass index >or= 40) increased from 0.6 to 4.4%. Overweight and obese patients were more likely to have diabetes, hypertension, familial coronary disease, and hyperlipidemia than persons with normal weight but less likely to have comorbidities (obstructive lung disease, heart failure, cancer, renal failure, and stroke) [all p values < 0.05]. When compared to patients with normal weight, after adjusting for age and other confounders, overweight and obese patients had a lower mortality (risk ratio [RR], 0.84; 95% confidence interval [CI], 0.73 to 0.96 for overweight; and RR, 0.85; 95% CI, 0.72 to 1.02 for obese) and a similar risk of cardiac events.
The prevalence of overweight and obese individuals among patients with MI is high and increased over time. Despite a higher prevalence of other cardiovascular risk factors among patients with excess weight, these patients did not experience worse outcomes, underscoring the need to further study the paradoxical relation between weight and post-MI outcomes.
确定心肌梗死（MI）患者中超重和肥胖个体的患病率趋势，并评估体重与MI后预后之间的关联。
基于人群的队列研究。
使用标准化标准对1979年至1998年间发生在明尼苏达州奥尔姆斯特德县的心肌梗死进行验证。从社区医疗记录中确定临床特征和预后。分析超重的患病率和趋势及其与预后的关联。
2277例新发MI患者中有64%超重或肥胖。超重/肥胖患者的患病率从1979年至1983年期间的58%增加到1994年至1998年期间的72%（p<0.001），而3级肥胖（体重指数≥40）的患病率从0.6%增加到4.4%。与体重正常者相比，超重和肥胖患者更易患糖尿病、高血压、家族性冠心病和高脂血症，但合并症（阻塞性肺病、心力衰竭、癌症、肾衰竭和中风）的发生率较低[所有p值<0.05]。与体重正常的患者相比，在调整年龄和其他混杂因素后，超重和肥胖患者的死亡率较低（风险比[RR]，0.84；95%置信区间[CI]，超重者为0.73至0.96；肥胖者RR为0.85；95%CI，0.72至1.02），心脏事件风险相似。
MI患者中超重和肥胖个体的患病率很高，且随时间增加。尽管超重患者中其他心血管危险因素的患病率较高，但这些患者的预后并未更差，这突出表明需要进一步研究体重与MI后预后之间的矛盾关系。
