高中身体质量指数和进入心脏病风险预防诊所时的身体质量指数与全因死亡率和冠心病的关系：PreCIS 数据库研究。

High school body mass index and body mass index at entry to a cardiac disease risk prevention clinic and the association to all-cause mortality and coronary heart disease: a PreCIS database study.

机构信息

Preventive Cardiology and Rehabilitation and Nurse Manager, Women's Cardiovascular Center, Cleveland Clinic, Ohio, USA.

出版信息

J Cardiovasc Nurs. 2010 Mar-Apr;25(2):99-105. doi: 10.1097/JCN.0b013e3181bdbc4c.

DOI:10.1097/JCN.0b013e3181bdbc4c

PMID:20168189

Abstract

OBJECTIVE

: To investigate overweight/obese patients (body mass index [BMI], > or =25 kg/m) at entry to a preventive cardiology clinic who had a high school (HS) BMI of 25 kg/m or greater versus those with a BMI of less than 25 kg/m to determine coronary heart disease (CHD) prevalence, all-cause mortality.

METHODS

: Patients (n = 4,597) who had a BMI of 25 kg/m or greater at the time of initial visit to the prevention clinic were asked to report their weight at graduation from HS. Patients with BMI of 25 kg/m or greater in HS (n = 1,285) were compared with patients (n = 3,312) with a BMI of less than 25 kg/m in HS. Prevalent CHD was assessed at entry. Patient mortality was assessed using the Social Security Death Index for a maximum of 7 years after the initial visit.

RESULTS

: Mean/median values for most CHD risk factors were higher in the group with an HS BMI of 25 kg/m or greater, with the exception of low-density lipoprotein level (120 vs 132 mg/dL; P < .001), Lipoprotein (a) level (16 vs 19 mg/dL; P = .003), and systolic blood pressure (126 vs 128. 3 mm Hg; P < .001). Patients with an HS BMI of 25 kg/m or greater had a higher mean BMI at initial visit (33.9 vs 30.1; P < .001) and hemoglobin A1c (6.8% vs 6.3%; P < .001) and glucose concentrations (93 vs 91 mg/dL; P = .004), with a lower mean high-density lipoprotein level (43.2 vs 46.5 mg/dL; P < .001) as well as greater prevalence of smoking (16.2% vs 11.4%; P < .001), diabetes mellitus (32.4% vs 21.8%; P < .001), CHD (47.1% vs 43%; P = .01), and specifically myocardial infarction (25.8% vs 21.1%; P = .001). Fibrinogen and urine albumin-to-creatinine levels were elevated. After adjusting for risk factors, an HS BMI of 25 kg/m or greater was associated with a 21% higher prevalence of CHD (odds ratio, 1.20; P = .027). However, an HS BMI of 25 kg/m or greater was not a significant predictor of 7-year mortality (hazard ratio, 1.03; P = .84).

CONCLUSION

: Patients with an HS BMI of 25 kg/m or greater had more CHD risk factors compared with those with an HS BMI of less than 25 kg/m. Prevalence of CHD was also significantly higher in this group. However, an HS BMI of 25 kg/m or greater was not a significant predictor of mortality.

摘要

目的

调查进入预防心脏病学诊所的超重/肥胖患者（体重指数[BMI]，≥25 kg/m2），他们在进入诊所时的高中（HS）BMI 为 25 kg/m2 或更高，与 BMI 低于 25 kg/m2 的患者相比，以确定冠心病（CHD）的患病率和全因死亡率。

方法

对 BMI 为 25 kg/m2 或更高的初次就诊预防诊所的患者（n=4597）进行调查，要求他们报告高中时的体重。将 BMI 为 25 kg/m2 或更高的 HS 患者（n=1285）与 BMI 低于 25 kg/m2 的患者（n=3312）进行比较。在初次就诊时评估已患冠心病。使用社会安全死亡指数评估患者的死亡率，最长随访时间为 7 年。

结果

在 BMI 为 25 kg/m2 或更高的 HS 组中，大多数 CHD 危险因素的均值/中位数均较高，除了低密度脂蛋白水平（120 与 132 mg/dL；P<.001）、脂蛋白（a）水平（16 与 19 mg/dL；P=.003）和收缩压（126 与 128.3 mmHg；P<.001）外。BMI 为 25 kg/m2 或更高的 HS 组的患者在初次就诊时的平均 BMI 更高（33.9 与 30.1；P<.001），血红蛋白 A1c（6.8% 与 6.3%；P<.001）和血糖浓度（93 与 91 mg/dL；P=.004）更高，高密度脂蛋白水平（43.2 与 46.5 mg/dL；P<.001）更低，吸烟率（16.2% 与 11.4%；P<.001）、糖尿病（32.4% 与 21.8%；P<.001）、CHD（47.1% 与 43%；P=.01），特别是心肌梗死（25.8% 与 21.1%；P=.001）的患病率更高。纤维蛋白原和尿白蛋白与肌酐比值升高。在校正危险因素后，HS BMI 为 25 kg/m2 或更高与 CHD 患病率增加 21%相关（比值比，1.20；P=.027）。然而，HS BMI 为 25 kg/m2 或更高并不是 7 年死亡率的显著预测因素（风险比，1.03；P=.84）。