Kydd Anna, Pugh Peter J
Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge, UK.
Expert Rev Cardiovasc Ther. 2009 Mar;7(3):263-7. doi: 10.1586/14779072.7.3.263.
Evaluation of: Pocock SJ, McMurray JJV, Dobson J et al. Weight loss and mortality risk in patients with chronic heart failure in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur. Heart J. 29, 2641-2650 (2008). Among patients with heart failure, the usual association between obesity and reduced survival appears to be turned on its head. Increasing numbers of studies appear to confirm the apparent protective effect of the 'obesity paradox' in heart failure. The adverse effects of weight loss and cachexia have been recognized among patients with chronic disease. The paper under evaluation clarifies and offers further insight into the impact of BMI and weight loss on prognosis in a large sample of heart failure patients. The results confirm and extend previous knowledge. They raise many questions, not only regarding the underlying pathophysiology that leads to this counterintuitive relationship observed in the obese heart failure group, but also as to how we should best approach and advise these patients on weight management in day-to-day practice.
波科克 SJ、麦克默里 JJV、多布森 J 等。《坎地沙坦治疗心力衰竭：降低死亡率和发病率评估（CHARM）项目中慢性心力衰竭患者的体重减轻与死亡风险》。《欧洲心脏杂志》29 卷，2641 - 2650 页（2008 年）。在心力衰竭患者中，肥胖与生存率降低之间通常的关联似乎被颠倒了。越来越多的研究似乎证实了“肥胖悖论”在心力衰竭中的明显保护作用。体重减轻和恶病质的不良影响在慢性病患者中已得到认可。所评估的这篇论文阐明并进一步深入探讨了体重指数（BMI）和体重减轻对大量心力衰竭患者预后的影响。研究结果证实并扩展了先前的认识。它们提出了许多问题，不仅涉及导致在肥胖心力衰竭组中观察到这种违反直觉关系的潜在病理生理学，还涉及在日常实践中我们应如何最好地处理这些患者的体重管理问题并给予建议。
