类风湿关节炎患者低体重指数与心血管死亡率的预后重要性

Prognostic importance of low body mass index in relation to cardiovascular mortality in rheumatoid arthritis.

作者信息

Kremers Hilal Maradit, Nicola Paulo J, Crowson Cynthia S, Ballman Karla V, Gabriel Sherine E

机构信息

Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

出版信息

Arthritis Rheum. 2004 Nov;50(11):3450-7. doi: 10.1002/art.20612.

DOI:10.1002/art.20612

PMID:15529378

Abstract

OBJECTIVE

Various etiologic mechanisms have been implicated in the observed increase in cardiovascular mortality in rheumatoid arthritis (RA). Body mass index (BMI) is associated with cardiovascular mortality in the general population. This study compared the effect of BMI on cardiovascular mortality in a population-based cohort of subjects with RA with that in a cohort of individuals without RA from the same population.

METHODS

The RA cohort comprised all members of an incidence cohort of Rochester, Minnesota residents ages > or =18 years who were first diagnosed with RA (by the American College of Rheumatology 1987 criteria) from 1955 through 1994. An age- and sex-matched comparison cohort of subjects without RA was assembled. Both cohorts were followed up longitudinally through their complete (inpatient, outpatient) medical records beginning at age 18 years and continuing until death, migration, or January 1, 2001, and the details of weight and height changes during this period were recorded. High BMI was defined as a BMI >30 kg/m(2) and low BMI as <20 kg/m(2). Cox regression models were used to estimate the effect of BMI on cardiovascular mortality after accounting for traditional cardiac risk factors and malignancies.

RESULTS

RA subjects with low BMI at incidence had a significantly higher risk of cardiovascular death (hazard ratio [HR] 3.34, 95% confidence interval [95% CI] 2.23-4.99) compared with non-RA subjects with normal BMI, after adjusting for age, sex, personal cardiac history, smoking status, and presence of diabetes, hypertension, and malignancies. RA subjects with normal BMI at incidence who experienced low BMI during followup also had a higher risk of cardiovascular death (HR 2.09, 95% CI 1.50-2.92) when compared with non-RA subjects who maintained normal BMI throughout followup.

CONCLUSION

Among patients with RA, low BMI is associated with a significantly increased risk of cardiovascular death.

摘要

目的

类风湿关节炎（RA）患者心血管疾病死亡率上升，其病因机制多样。在普通人群中，体重指数（BMI）与心血管疾病死亡率相关。本研究比较了以人群为基础的RA患者队列与同一人群中无RA个体队列的BMI对心血管疾病死亡率的影响。

方法

RA队列包括1955年至1994年在明尼苏达州罗切斯特市首次被诊断为RA（根据美国风湿病学会1987年标准）、年龄≥18岁的发病率队列的所有成员。选取年龄和性别匹配的无RA对照队列。两个队列均从18岁开始通过其完整（住院、门诊）病历进行纵向随访，直至死亡、迁移或2001年1月1日，并记录在此期间体重和身高变化的详细信息。高BMI定义为BMI>30 kg/m²，低BMI定义为<20 kg/m²。在考虑传统心脏危险因素和恶性肿瘤后，使用Cox回归模型估计BMI对心血管疾病死亡率的影响。

结果

在调整年龄、性别、个人心脏病史、吸烟状况以及糖尿病、高血压和恶性肿瘤的存在后，发病时BMI低的RA患者与BMI正常的非RA患者相比，心血管死亡风险显著更高（风险比[HR] 3.34，95%置信区间[95%CI] 2.23 - 4.99）。发病时BMI正常但随访期间BMI降低的RA患者与整个随访期间维持正常BMI的非RA患者相比，心血管死亡风险也更高（HR 2.09，95%CI 1.50 - 2.92）。