Wee Christina C, Girotra Saket, Weinstein Amy R, Mittleman Murray A, Mukamal Kenneth J
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
J Am Coll Cardiol. 2008 Aug 19;52(8):620-5. doi: 10.1016/j.jacc.2008.05.021.
This study examines whether obesity accelerates atherogenic progression or adverse outcomes after coronary artery bypass graft (CABG) surgery.
Obesity is a major risk factor for developing coronary heart disease. Whether obesity accelerates disease progression after CABG is unclear.
We examined how body mass index (BMI) related to atherosclerotic graft progression and a clinical composite outcome of death, nonfatal myocardial infarction, stroke, CABG surgery, or angioplasty among 1,314 participants in the Post CABG trial. Participants who had undergone CABG surgery were randomly assigned in a 2 x 2 factorial design to warfarin versus placebo and aggressive low-density lipoprotein cholesterol (LDL-C) lowering with lovastatin 40 to 80 mg/day (to achieve LDL-C of 60 to 85 mg/dl) versus moderate LDL-C lowering with lovastatin 2.5 to 5 mg/day (to achieve LDL-C of 130 to 140 mg/dl). Angiographic progression was assessed by coronary angiography at 4 to 5 years.
Higher BMI was associated with a higher likelihood of angiographic progression (p trend = 0.003) after adjustment for demographic factors, treatment assignment, smoking status, and years since CABG surgery, but not with clinical events (p trend = 0.81). In stratified analyses, higher BMI was associated with angiographic progression in the low-dose lovastatin group (p trend <0.001) but not in the high-dose group (p = 0.03 for test for interaction of BMI and statin treatment). In the high-dose lovastatin group, higher BMI appeared to be protective against clinical events (p trend = 0.06, test of interaction: 0.02).
Higher BMI is strongly associated with atherogenic progression after CABG surgery. Aggressive statin therapy may be protective against obesity-related acceleration of coronary heart disease.
本研究旨在探讨肥胖是否会加速冠状动脉旁路移植术（CABG）后动脉粥样硬化进展或不良结局。
肥胖是冠心病发生的主要危险因素。肥胖是否会加速CABG术后疾病进展尚不清楚。
我们在CABG术后试验的1314名参与者中，研究了体重指数（BMI）与动脉粥样硬化移植物进展以及死亡、非致命性心肌梗死、中风、CABG手术或血管成形术的临床综合结局之间的关系。接受CABG手术的参与者按2×2析因设计随机分配至华法林组与安慰剂组，以及使用40至80毫克/天洛伐他汀积极降低低密度脂蛋白胆固醇（LDL-C）（使LDL-C达到60至85毫克/分升）组与使用2.5至5毫克/天洛伐他汀适度降低LDL-C（使LDL-C达到130至140毫克/分升）组。在4至5年时通过冠状动脉造影评估血管造影进展情况。
在调整人口统计学因素、治疗分配、吸烟状况和CABG术后年限后，较高的BMI与血管造影进展的可能性较高相关（p趋势=0.003），但与临床事件无关（p趋势=0.81）。在分层分析中，较高的BMI与低剂量洛伐他汀组的血管造影进展相关（p趋势<0.001），但与高剂量组无关（BMI与他汀类药物治疗的交互作用检验p=0.03）。在高剂量洛伐他汀组中，较高的BMI似乎对临床事件有保护作用（p趋势=0.06，交互作用检验：0.02）。
较高的BMI与CABG术后动脉粥样硬化进展密切相关。积极的他汀类药物治疗可能对肥胖相关的冠心病加速有保护作用。
