Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
J Am Coll Cardiol. 2011 May 10;57(19):1877-86. doi: 10.1016/j.jacc.2010.11.058.
The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients.
The question of which measure of obesity better predicts survival in patients with CAD is controversial.
We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months.
From 2,188 studies found, 6 met inclusion criteria. We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort. A variable called "central obesity" was created on the basis of tertiles of WHR or WC. Cox-proportional hazards were adjusted for age, sex, and confounders. The final sample consisted of 15,923 subjects. There were 5,696 deaths after a median follow-up of 2.3 (interquartile range 0.5 to 7.4) years. Central obesity was associated with mortality (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.58 to 1.83), whereas BMI was inversely associated with mortality (HR: 0.64, 95% CI: 0.59 to 0.69). Central obesity was also associated with higher mortality in the subset of subjects with normal BMI (HR: 1.70, 95% CI: 1.52 to 1.89) and BMI ≥30 kg/m(2) (HR: 1.93, 95% CI: 1.61 to 2.32).
In subjects with CAD, including those with normal and high BMI, central obesity but not BMI is directly associated with mortality.
本研究旨在探讨中心性肥胖（腰围[WC]和腰臀比[WHR]）和全身肥胖（体重指数[BMI]）指标与冠心病（CAD）患者死亡率的关系。
关于哪种肥胖指标能更好地预测 CAD 患者的生存率，目前仍存在争议。
我们检索了 1980 年至 2008 年的 OVID/Medline、EMBASE、CENTRAL 和 Web of Science，并向该领域的专家询问了符合纳入标准的未发表数据，这些数据均满足以下标准：1）基线时患有 CAD；2）有 WC 或 WHR 测量值；3）有死亡率数据；4）随访时间至少 6 个月。
从 2188 项研究中，我们找到了 6 项符合纳入标准的研究。我们从 4 项研究中获取了个体患者数据，并增加了来自心脏康复队列的未发表数据。根据 WHR 或 WC 的三分位数创建了一个名为“中心性肥胖”的变量。Cox 比例风险模型调整了年龄、性别和混杂因素。最终样本包括 15923 例患者。中位随访 2.3 年（四分位间距 0.5 至 7.4 年）后，有 5696 例患者死亡。中心性肥胖与死亡率相关（风险比[HR]：1.70，95%置信区间[CI]：1.58 至 1.83），而 BMI 与死亡率呈负相关（HR：0.64，95% CI：0.59 至 0.69）。在 BMI 正常和 BMI≥30kg/m²的患者亚组中，中心性肥胖与更高的死亡率相关（HR：1.70，95% CI：1.52 至 1.89）和（HR：1.93，95% CI：1.61 至 2.32）。
在 CAD 患者中，包括 BMI 正常和较高的患者，中心性肥胖而非 BMI 与死亡率直接相关。
