Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Am J Cardiol. 2010 Nov 1;106(9):1270-6. doi: 10.1016/j.amjcard.2010.06.055.
Obesity is associated with hypertension, dyslipidemia, and diabetes, but it is also an independent cardiovascular risk factor. We sought to evaluate the differences in treatment patterns and attainment of guideline-recommended targets among high-risk vascular outpatients in relation to their body mass index (BMI). The prospective Vascular Protection and Guideline Orientated Approach to Lipid Lowering Registries recruited 7,357 high-risk vascular outpatients in Canada from 2001 to 2004. We stratified the patient population into 3 groups according to their BMI: normal weight (BMI <24.9 kg/m²), overweight (BMI 25 to 29.9 kg/m²), and obese (BMI >30 kg/m²). We evaluated the rates of attainment for contemporary guideline targets of blood pressure (<140/90 or <130/80 mm Hg in the presence of diabetes) and lipids (low-density lipoprotein [LDL] <2.5 mmol/L [96.7 mg/dl] and total cholesterol [TC]/high-density lipoprotein [HDL] ratio <4.0). Of the 7,357 patients, 1,305 (17.7%) were normal weight, 2,791 (37.9%) overweight, and 3,261 (44.4%) obese, as determined by the BMI. Obese patients were younger and more likely to have hypertension and diabetes (all p <0.001 for trend). Obese patients had higher baseline blood pressure, TC, LDL cholesterol, triglyceride levels and TC/HDL ratio, and lower HDL cholesterol. Obese patients were more likely to be treated with antihypertensive agents (p = 0.002), angiotensin-converting enzyme inhibitors (p = 0.024), angiotensin receptor blockers (p <0.001), and high-dose statin therapy (p = 0.001). On multivariable analyses, obese patients were less likely to attain the blood pressure (odds ratio 0.77, 95% confidence interval 0.66 to 0.90, p = 0.001) and TC/HDL ratio (odds ratio 0.48, 95% confidence interval 0.42 to 0.55, p <0.001) targets but not the LDL targets (odds ratio 0.89, 95% confidence interval 0.78 to 1.03, p = 0.11). In conclusion, only a minority ambulatory patients at high cardiovascular risk achieved both guideline-recommended blood pressure and lipid targets, and this significant treatment gap was more pronounced among obese patients. Our findings underscore the opportunity to optimize the treatment of these high-risk patients.
肥胖与高血压、血脂异常和糖尿病有关，但它也是心血管的独立危险因素。我们旨在评估与身体质量指数（BMI）相关的高危血管门诊患者在治疗模式和达到指南推荐目标方面的差异。从 2001 年到 2004 年，前瞻性血管保护和以指南为导向的降脂注册研究在加拿大招募了 7357 名高危血管门诊患者。我们根据 BMI 将患者人群分为 3 组：正常体重（BMI<24.9kg/m²）、超重（BMI 25-29.9kg/m²）和肥胖（BMI>30kg/m²）。我们评估了当代指南目标的达标率，包括血压（无糖尿病患者<140/90mmHg，有糖尿病患者<130/80mmHg）和血脂（低密度脂蛋白[LDL]<2.5mmol/L[96.7mg/dl]和总胆固醇[TC]/高密度脂蛋白[HDL]比值<4.0）。在 7357 名患者中，根据 BMI，1305 名（17.7%）为正常体重，2791 名（37.9%）为超重，3261 名（44.4%）为肥胖。肥胖患者更年轻，更有可能患有高血压和糖尿病（所有趋势 p<0.001）。肥胖患者的基线血压、TC、LDL 胆固醇、甘油三酯水平和 TC/HDL 比值更高，而 HDL 胆固醇水平更低。肥胖患者更有可能接受降压药物治疗（p=0.002）、血管紧张素转换酶抑制剂（p=0.024）、血管紧张素受体阻滞剂（p<0.001）和高剂量他汀类药物治疗（p=0.001）。多变量分析显示，肥胖患者血压（比值比 0.77，95%置信区间 0.66 至 0.90，p=0.001）和 TC/HDL 比值（比值比 0.48，95%置信区间 0.42 至 0.55，p<0.001）目标达标率较低，但 LDL 目标达标率（比值比 0.89，95%置信区间 0.78 至 1.03，p=0.11）无差异。总之，只有少数高心血管风险的门诊患者同时达到了指南推荐的血压和血脂目标，而肥胖患者的这一显著治疗差距更为明显。我们的研究结果强调了优化这些高危患者治疗的机会。
