Diercks Deborah B, Roe Matthew T, Mulgund Jyotsna, Pollack Charles V, Kirk J Douglas, Gibler W Brian, Ohman E Magnus, Smith Sidney C, Boden William E, Peterson Eric D
Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA, USA.
Am Heart J. 2006 Jul;152(1):140-8. doi: 10.1016/j.ahj.2005.09.024.
Although obesity is a known risk factor for coronary artery disease, its impact on the presentation, treatment, and outcome of patients with acute coronary syndromes (ACS) has not been well studied.
Using data from the CRUSADE Initiative, we compared inhospital treatments and clinical outcomes of 80845 patients with high-risk non-ST-segment elevation (NSTE) ACS (positive cardiac markers and/or ischemic ST-segment changes) to determine whether there was an association with body mass index (BMI [kg/m2]). Patient weights were categorized according to World Health Organization classifications: Underweight (BMI <18.5), Normal range (BMI 18.5-24.9), Overweight (BMI 25-29.9), Obese Class I (BMI 30-34.9), Obese Class II (BMI 35-39.9), and Extremely Obese (BMI =40).
Most (70.5%) of the CRUSADE patients were classified as overweight or obese; these patients were younger and more likely to present with comorbid conditions, including diabetes mellitus, hypertension, and hyperlipidemia. Medications given during the first 24 hours and invasive cardiac procedures recommended by the American College of Cardiology/American Heart Association guidelines for NSTE ACS were more commonly used in these patients. The incidence of death and death and reinfarction, adjusted for covariates, were generally lower in overweight and obese patients, compared with normal-weight patients, but higher in underweight and extremely obese patients.
Most patients with NSTE ACS are overweight or obese. These patients receive more aggressive treatment, and, except for the extremely obese, have less adverse outcomes compared with underweight and normal-weight patients. Although obesity appears to be a risk factor for developing ACS at a younger age, it also appears to be associated with more aggressive ACS management and, ultimately, improved outcomes.
尽管肥胖是冠状动脉疾病已知的危险因素，但其对急性冠状动脉综合征（ACS）患者的临床表现、治疗及预后的影响尚未得到充分研究。
利用“降低急性冠状动脉综合征患者死亡、再发心肌梗死及紧急住院风险（CRUSADE）倡议”的数据，我们比较了80845例高危非ST段抬高型（NSTE）ACS患者（心肌标志物阳性和/或缺血性ST段改变）的住院治疗情况及临床结局，以确定其与体重指数（BMI[kg/m²]）是否存在关联。患者体重根据世界卫生组织分类进行划分：体重过轻（BMI<18.5）、正常范围（BMI 18.5 - 24.9）、超重（BMI 25 - 29.9）、肥胖I级（BMI 30 - 34.9）、肥胖II级（BMI 35 - 39.9）及极度肥胖（BMI≥40）。
大多数（70.5%）CRUSADE患者被分类为超重或肥胖；这些患者更年轻，更易出现合并症，包括糖尿病、高血压和高脂血症。美国心脏病学会/美国心脏协会NSTE ACS指南推荐的首24小时内给予的药物治疗及侵入性心脏操作在这些患者中更常用。在校正协变量后，超重和肥胖患者的死亡、死亡及再梗死发生率通常低于体重正常患者，但体重过轻和极度肥胖患者的发生率更高。
大多数NSTE ACS患者超重或肥胖。这些患者接受更积极的治疗，除极度肥胖患者外，与体重过轻和体重正常患者相比，不良结局更少。尽管肥胖似乎是年轻时发生ACS的危险因素，但它似乎也与更积极的ACS管理相关，最终改善结局。
