Fadl Yazid Y, Krumholz Harlan M, Kosiborod Mikhail, Masoudi Frederick A, Peterson Pamela N, Reid Kimberly J, Weintraub William S, Buchanan Donna M, Spertus John A
Washington University in St. Louis, St. Louis, MO, USA.
Am Heart J. 2007 Oct;154(4):711-7. doi: 10.1016/j.ahj.2007.06.006.
Weight loss is recommended among overweight survivors of myocardial infarction (MI). This study describes patterns of weight change among overweight patients with MI and identifies factors associated with weight change.
A prospective cohort of 1253 overweight or heavier (body mass index [BMI] > or = 25 kg/m2) post-MI patients were enrolled in the 19-center PREMIER study and followed up for 1 year to determine changes in weight. Patients were categorized at 1 month as overweight (BMI = 25-29.9 kg/m2), obese (BMI = 30-39.9 kg/m2), or morbidly obese (BMI > or = 40 kg/m2). Unadjusted percent weight change was assessed at 1 year, and multivariable linear regression was used to identify independent correlates of change.
Mean weight change was -0.2% and varied by the severity of baseline obesity (+0.4% for overweight patients, -0.5% for obese patients, and -3.7% for morbidly obese patients [P < .001]). Multivariable analyses revealed the following to be significantly associated with weight change: depression 1 month post-MI (+2.7%, P = .001), lack of health insurance (+2%, P = .01), smoking cessation 1 month post-MI (+2.7% vs current smokers, P < .001), morbid obesity (+4.7% vs overweight patients, P < .0001), and increasing age (-0.8% per decade, P = .001). An interaction between smoking cessation and weight class was detected in that overweight patients who quit had a mean increase of 5.3% (95% CI 3.1%-7.4%), whereas no significant change was observed among obese and morbidly obese patients who quit.
Although post-MI patients had negligible weight loss over 1 year, several sociodemographic, clinical, and lifestyle characteristics were associated with weight change. New, targeted interventions will likely be needed to improve weight management after an MI.
对于心肌梗死（MI）的超重幸存者，建议进行体重减轻。本研究描述了超重心肌梗死患者的体重变化模式，并确定与体重变化相关的因素。
1253名超重或更重（体重指数[BMI]≥25kg/m²）的心肌梗死后患者纳入了19中心的PREMIER研究，随访1年以确定体重变化。患者在1个月时被分类为超重（BMI=25-29.9kg/m²）、肥胖（BMI=30-39.9kg/m²）或病态肥胖（BMI≥40kg/m²）。在1年时评估未调整的体重变化百分比，并使用多变量线性回归来确定变化的独立相关因素。
平均体重变化为-0.2%，并因基线肥胖的严重程度而异（超重患者为+0.4%，肥胖患者为-0.5%，病态肥胖患者为-3.7%[P<.001]）。多变量分析显示以下因素与体重变化显著相关：心肌梗死后1个月的抑郁（+2.7%，P=.001）、缺乏医疗保险（+2%，P=.01）、心肌梗死后1个月戒烟（与当前吸烟者相比增加2.7%，P<.001）、病态肥胖（与超重患者相比增加4.7%，P<.0001）以及年龄增长（每十年-0.8%，P=.001）。检测到戒烟与体重类别之间存在交互作用，即戒烟的超重患者平均增加5.3%（95%CI 3.1%-7.4%），而戒烟的肥胖和病态肥胖患者未观察到显著变化。
尽管心肌梗死后患者在1年内体重减轻可忽略不计，但一些社会人口统计学、临床和生活方式特征与体重变化相关。可能需要新的、有针对性的干预措施来改善心肌梗死后的体重管理。
