Bozkurt Biykem, Deswal Anita
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Am Heart J. 2005 Dec;150(6):1233-9. doi: 10.1016/j.ahj.2005.02.004.
Obesity is considered as an independent risk factor for development of heart failure (HF); however, its role in the progression of HF independent of atherosclerotic heart disease, hypertension, and diabetes is not well described.
To identify the role of obesity in HF outcomes, we analyzed the Digitalis Investigation Group database with 7788 patients with chronic stable HF. Subjects with body mass index of > or = 18.5 and < 25 kg/m2 were categorized as normal weight, > or = 25.0 and < 30 kg/m2 as overweight, and > or = 30.0 kg/m2 as obese.
Compared with normal weight, overweight or obese patients had lower all-cause mortality (37.8%, 32.4%, and 28.5%, P < .0001) and lower HF mortality (38.7%, 31.2%, and 33.6%, P = .01). After adjustment for differences in baseline characteristics, the overweight (HR 0.87, 95% CI 0.79-0.95, P = .002) and the obese (HR 0.82, 95% CI 0.73-0.92, P = .0005) had better survival rates compared with normal-weight groups. Similarly, the overweight (HR 0.76, 95% CI 0.65-0.88, P = .0003) or the obese (HR 0.79, 95% CI 0.63-0.88, P = .005) patients had better HF survival rates. After adjustment for baseline differences, the rate of hospitalizations was similar in the 3 groups.
In patients with chronic symptomatic HF, obesity or overweight status was associated with a lower risk for mortality but a similar risk for hospitalization compared with normal weight status. Prospective studies evaluating the risks and benefits of sustenance of obesity or weight loss are needed in this population.
肥胖被认为是心力衰竭（HF）发生的独立危险因素；然而，其在不依赖动脉粥样硬化性心脏病、高血压和糖尿病的HF进展中的作用尚未得到充分描述。
为确定肥胖在HF预后中的作用，我们分析了洋地黄调查组数据库中7788例慢性稳定HF患者的数据。体重指数≥18.5且<25kg/m²的受试者被归类为正常体重，≥25.0且<30kg/m²为超重，≥30.0kg/m²为肥胖。
与正常体重者相比，超重或肥胖患者的全因死亡率较低（分别为37.8%、32.4%和28.5%，P<.0001），HF死亡率也较低（分别为38.7%、31.2%和33.6%，P=.01）。在对基线特征差异进行调整后，超重者（风险比[HR]0.87，95%置信区间[CI]0.79-0.95，P=.002）和肥胖者（HR0.82，95%CI0.73-0.92，P=.0005）的生存率优于正常体重组。同样，超重（HR0.76，95%CI0.65-0.88，P=.0003）或肥胖（HR0.79，95%CI0.63-0.88，P=.005）患者的HF生存率更高。在对基线差异进行调整后，三组的住院率相似。
在慢性症状性HF患者中，与正常体重状态相比，肥胖或超重状态与较低的死亡风险相关，但住院风险相似。需要对该人群进行前瞻性研究，以评估维持肥胖或减肥的风险和益处。
