Nagarajan Vijaiganesh, Cauthen Clay A, Starling Randall C, Tang Wai Hong Wilson
Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
Congest Heart Fail. 2013 Jul-Aug;19(4):160-4. doi: 10.1111/chf.12038.
Obese patients have been noted to have better prognosis in many conditions including heart failure. We hypothesize that this favorable prognosis for obesity may not be seen in patients with morbid obesity and advanced heart failure. A total of 501 consecutive patients with advanced heart failure referred for heart transplant evaluation to the Cleveland Clinic were studied. Patients were categorized into 3 groups based on their body mass index score as nonobese (≤30 kg/m(2) ), obese (30.1-40 kg/m(2) ), and morbidly obese (≥40 kg/m(2) ). There were fewer cardiovascular risk factors in the morbidly obese group. Unadjusted event-free survival rates were 48.4%, 57.4%, and 28.6% in the nonobese, obese, and morbidly obese groups, respectively (P=.02). In univariate analysis, both the nonobese group (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.09-1.91; P=.01) and the morbidly obese group (HR, 2.46; 95% CI, 1.40-4.30; P=.002) had significantly higher risk of all-cause mortality/transplantation compared with the obese group. This difference persisted in multivariate analysis after adjustment for confounding factors. Our study re-emphasizes the presence of an obesity paradox even in patients with very advanced heart failure. This favorable prognosis, however, may not be relevant in patients with morbidly obesity. Cardiovascular risk factors may not contribute to this phenomenon.
肥胖患者在包括心力衰竭在内的多种疾病中被发现预后较好。我们推测，在病态肥胖和晚期心力衰竭患者中可能看不到肥胖带来的这种良好预后。对连续501例转诊至克利夫兰诊所进行心脏移植评估的晚期心力衰竭患者进行了研究。根据体重指数评分，患者被分为3组：非肥胖（≤30kg/m²）、肥胖（30.1 - 40kg/m²）和病态肥胖（≥40kg/m²）。病态肥胖组的心血管危险因素较少。非肥胖组、肥胖组和病态肥胖组的未调整无事件生存率分别为48.4%、57.4%和28.6%（P = 0.02）。在单因素分析中，与肥胖组相比，非肥胖组（风险比[HR]，1.44；95%置信区间[CI]，1.09 - 1.91；P = 0.01）和病态肥胖组（HR，2.46；95%CI，1.40 - 4.30；P = 0.002）的全因死亡率/移植风险显著更高。在对混杂因素进行调整后的多因素分析中，这种差异仍然存在。我们的研究再次强调，即使在非常晚期的心力衰竭患者中也存在肥胖悖论。然而，这种良好的预后可能与病态肥胖患者无关。心血管危险因素可能与这一现象无关。
