Shah Ravi V, Abbasi Siddique A, Yamal José-Miguel, Davis Barry R, Barzilay Joshua, Einhorn Paula T, Goldfine Alison B
Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA.
J Clin Hypertens (Greenwich). 2014 Jun;16(6):451-8. doi: 10.1111/jch.12325. Epub 2014 Apr 29.
Emerging literature suggests that obesity may be "protective" against mortality and cardiovascular outcomes, while dysglycemia may worsen outcomes regardless of obesity. The authors measured the association of weight, smoking, and glycemia with mortality in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Among 5423 ALLHAT participants without established diabetes or cardiovascular disease, 3980 (73%) had normal fasting glucose and 1443 (27%) had impaired fasting glucose (IFG) levels at study entry. After a median of 4.9 years follow-up, 554 (10%) had died (37% cardiovascular). IFG was associated with higher all-cause mortality (adjusted hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.02-1.50), while obesity was associated with lower all-cause mortality (adjusted HR, 0.76; 95% CI, 0.60-0.96). However, after excluding underweight individuals (body mass index [BMI] <22 kg/m(2) ) and smokers, neither obesity nor IFG was associated with all-cause mortality [corrected]. Although obesity appeared protective against mortality, this association was not significant in never-smokers or after exclusion of BMI <22 kg/m(2) . The obesity paradox may result from confounding by a sicker, underweight referent population and smoking.
新出现的文献表明，肥胖可能对死亡率和心血管疾病结局具有“保护作用”，而血糖异常可能会使结局恶化，无论是否肥胖。作者在抗高血压和降脂治疗预防心脏病发作试验（ALLHAT）中测量了体重、吸烟和血糖与死亡率之间的关联。在5423名无糖尿病或心血管疾病病史的ALLHAT参与者中，3980名（73%）在研究开始时空腹血糖正常，1443名（27%）空腹血糖受损（IFG）。经过中位数4.9年的随访，554名（10%）死亡（37%为心血管疾病死亡）。IFG与全因死亡率较高相关（调整后风险比[HR]，1.23；95%置信区间[CI]，1.02 - 1.50），而肥胖与全因死亡率较低相关（调整后HR，0.76；95%CI，0.60 - 0.96）。然而，在排除体重过轻个体（体重指数[BMI]<22 kg/m²）和吸烟者后，肥胖和IFG均与全因死亡率无关[校正后]。尽管肥胖似乎对死亡率有保护作用，但这种关联在从不吸烟者中或排除BMI<22 kg/m²后并不显著。肥胖悖论可能是由于病情较重、体重过轻的参照人群和吸烟造成的混杂所致。
