Barba Raquel, Bisbe Josep, Pedrajas José Nicolas Alcalá, Toril Jesús, Monte Rafael, Muñoz-Torrero Juan Francisco Sánchez, Monreal Manuel
Department of Internal Medicine, Hospital Infanta Cristina, Madrid, Spain.
Eur J Cardiovasc Prev Rehabil. 2009 Aug;16(4):457-63. doi: 10.1097/HJR.0b013e32832b1818.
The relationship between body mass index (BMI) and mortality in patients with established arterial disease remains controversial.
FRENA is an ongoing, observational registry of consecutive outpatients with coronary artery disease (CAD), cerebrovascular disease, or peripheral artery disease (PAD). We examined the prognostic importance of accepted BMI categories on outcome among patients in the FRENA registry.
In April 2008, 2274 patients (mean age, 66 years) had been enrolled, of whom 14 (0.6%) were underweight; 533 (23%) normal; 1051 (46%) overweight; and 676 (30%) were obese. Over a mean follow-up of 14 months, the incidence of major cardiovascular events (myocardial infarction, ischemic stroke, or critical limb ischemia) per 100 patient-years was: 7.1 [95% confidence interval (CI): 0.4-35]; 11 (95% CI: 8.4-14); 6.9 (95% CI: 5.6-8.5); and 8.5 (95% CI: 6.6-11), respectively. Their cardiovascular mortality was: 7.1 (95% CI: 0.4-35); 4.1 (95% CI: 5.9-11); 1.3 (95% CI: 0.9-2.3); and 1.5 (95% CI: 1.4-3.5), respectively. On multivariate analysis, the hazard ratio for cardiovascular mortality was: 2.2 (95% CI: 0.3-17); 1.0 (reference); 0.37 (95% CI: 0.20-0.69); and 0.37 (95% CI: 0.18-0.73), respectively. Survival benefit was only found in patients with CAD or PAD. Weight loss had little influence on outcome.
Patients with CAD or PAD (not those with cerebrovascular disease) have an inverse correlation between BMI and cardiovascular mortality, even after adjusting for confounding variables.
在已确诊动脉疾病的患者中，体重指数（BMI）与死亡率之间的关系仍存在争议。
FRENA是一项正在进行的针对冠心病（CAD）、脑血管疾病或外周动脉疾病（PAD）连续门诊患者的观察性登记研究。我们在FRENA登记研究中检验了公认的BMI类别对患者预后的重要性。
2008年4月，共纳入2274例患者（平均年龄66岁），其中14例（0.6%）体重过轻；533例（23%）体重正常；1051例（46%）超重；676例（30%）肥胖。平均随访14个月，每100患者年主要心血管事件（心肌梗死、缺血性中风或严重肢体缺血）的发生率分别为：7.1[95%置信区间（CI）：0.4 - 35]；11（95%CI：8.4 - 14）；6.9（95%CI：5.6 - 8.5）；8.5（95%CI：6.6 - 11）。他们的心血管死亡率分别为：7.1（95%CI：0.4 - 35）；4.1（95%CI：5.9 - 11）；1.3（95%CI：0.9 - 2.3）；1.5（95%CI：1.4 - 3.5）。多因素分析显示，心血管死亡的风险比分别为：2.2（95%CI：0.3 - 17）；1.0（参照）；0.37（95%CI：0.20 - 0.69）；0.37（95%CI：0.18 - 0.73）。仅在CAD或PAD患者中发现生存获益。体重减轻对预后影响不大。
即使在调整混杂变量后，CAD或PAD患者（而非脑血管疾病患者）的BMI与心血管死亡率呈负相关。
