Preventive Cardiology and Rehabilitation and Nurse Manager, Women's Cardiovascular Center, Cleveland Clinic, Ohio, USA.
J Cardiovasc Nurs. 2010 Mar-Apr;25(2):99-105. doi: 10.1097/JCN.0b013e3181bdbc4c.
: 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.
: 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.
: 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).
: 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.
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。
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。
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）。
与 BMI 低于 25 kg/m2 的 HS 患者相比，BMI 为 25 kg/m2 或更高的 HS 患者的 CHD 危险因素更多。该组的 CHD 患病率也显著更高。然而，HS BMI 为 25 kg/m2 或更高并不是死亡率的显著预测因素。
