Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
J Vasc Surg. 2011 Feb;53(2):399-406. doi: 10.1016/j.jvs.2010.08.048. Epub 2010 Oct 20.
Obesity is a risk factor for atherosclerosis, a polyvascular process associated with reduced survival. In nonvascular surgery populations, a paradox between body mass index (BMI) and survival is described. This paradox includes reduced survival in underweight patients, whereas overweight and obese patients have a survival benefit. No clear explanation for this paradox has been given. Therefore, we evaluated the presence of the obesity paradox in vascular surgery patients and the influence of polyvascular disease on the obesity paradox.
In this retrospective study, 2933 consecutive patients were classified according to their preoperative BMI (kg/m(2)) and screened for polyvascular disease and cardiovascular risk factors before surgery. In addition, medication use at the time of discharge was noted. Outcome was all-cause mortality during a median follow-up of 6.0 years (interquartile range, 2-9 years).
BMI (kg/m(2)) groups included 68 (2.3%) underweight (BMI <18.5), 1379 (47.0%) normal (BMI 18.5-24.9, reference), 1175 (40.0%) overweight (BMI 25-29.9), and 311 (10.7%) obese (BMI ≥ 30) patients. No direct interaction between BMI, polyvascular disease, and long-term outcome was observed. Underweight was an independent predictor of mortality (hazard ratio, 1.65; 95% confidence interval, 1.22-2.22). In contrast, overweight protected for all-cause mortality (hazard ratio, 0.79; 95% confidence interval, 0.700-0.89). Cardioprotective medication usage in underweight patients was the lowest (P < .001), although treatment targets for risk factors were equally achieved within all treated groups.
Overweight patients referred for vascular surgery were characterized by an increased incidence of polyvascular disease and required more extensive medical treatment for cardiovascular risk factors at discharge. Long-term follow-up showed a paradox of reduced mortality in overweight patients.
肥胖是动脉粥样硬化的一个危险因素，动脉粥样硬化是一种多血管疾病，与生存率降低有关。在非血管手术人群中，描述了体重指数（BMI）与生存率之间的悖论。这种悖论包括体重不足患者的生存率降低，而超重和肥胖患者的生存率则有所提高。对于这种悖论，尚无明确的解释。因此，我们评估了血管外科患者中肥胖悖论的存在情况，以及多血管疾病对肥胖悖论的影响。
在这项回顾性研究中，我们根据术前 BMI（kg/m²）将 2933 例连续患者进行分类，并在手术前筛查多血管疾病和心血管危险因素。此外，还记录了出院时的药物使用情况。结果是在中位随访 6.0 年（四分位间距 2-9 年）期间的全因死亡率。
BMI（kg/m²）组包括 68 例（2.3%）体重不足（BMI<18.5）、1379 例（47.0%）正常（BMI 18.5-24.9，参考）、1175 例（40.0%）超重（BMI 25-29.9）和 311 例（10.7%）肥胖（BMI≥30）患者。BMI、多血管疾病与长期结局之间没有直接的相互作用。体重不足是死亡的独立预测因素（危险比，1.65；95%置信区间，1.22-2.22）。相反，超重可保护全因死亡率（危险比，0.79；95%置信区间，0.700-0.89）。体重不足患者的心脏保护药物使用率最低（P<0.001），尽管所有治疗组的危险因素治疗目标都相同。
接受血管手术的超重患者的多血管疾病发生率较高，并且出院时需要更广泛的心血管危险因素治疗。长期随访显示，超重患者的死亡率降低出现悖论。
