Wang Hai-Jun, Si Quan-Jin, Shan Zhao-Liang, Guo Yu-Tao, Lin Kun, Zhao Xiao-Ning, Wang Yu-Tang
Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China.
Healthcare Department 2, Hainan Branch of Chinese PLA General Hospital, Sanya, China.
PLoS One. 2015 Apr 7;10(4):e0123516. doi: 10.1371/journal.pone.0123516. eCollection 2015.
Obesity is considered to be related to recurrence of atrial fibrillation (AF), left atrial thrombus formation, and atrial remodeling. However, whether obesity is an independent risk factor for stroke and other thromboembolic events is still controversial.
This study aimed to investigate the effects of body mass index (BMI) on the risks of stroke, thromboembolism, and mortality in AF patients.
Patients who were diagnosed with nonvalvular AF were included in this observational, retrospective study. The study population was stratified by BMI at baseline. The Cox proportional hazard model was adopted to calculate adjusted hazard ratios of risk factors for adverse clinical events (stroke, thromboembolism, and mortality).
A total of 1286 AF patients (males, 78.30%; mean age, 74.50 years; 94.48% paroxysmal AF) were followed up for a median of 2.1 years (IQR: 1.5-2.9 years). Overall, 159 patients died. A total of 84 strokes and 35 thromboembolic events occurred. Multivariate analysis showed that overweight (25.0≤BMI<30.0 kg/m2) and age ≥75 years were independent risk factors for ischemic stroke (both P<0.01). Obesity (BMI ≥30.0 kg/m2), age ≥75 years, persistent/permanent AF, and prior thromboembolism were independent risk factors for thromboembolism (all P<0.05). Underweight (BMI <18.5 kg/m2), age ≥75 years, prior ischemic stroke/transient ischemic attack, renal dysfunction, and heart failure were independent risk factors for all-cause deaths (all P<0.05).
Overweight or obesity may be a risk factor of ischemic stroke and thromboembolism in AF patients. Excessive low weight is significantly associated with increased all-cause mortality.
肥胖被认为与心房颤动（AF）复发、左心房血栓形成及心房重构有关。然而，肥胖是否为卒中及其他血栓栓塞事件的独立危险因素仍存在争议。
本研究旨在探讨体重指数（BMI）对AF患者发生卒中、血栓栓塞及死亡风险的影响。
本观察性回顾性研究纳入诊断为非瓣膜性AF的患者。研究人群根据基线BMI进行分层。采用Cox比例风险模型计算不良临床事件（卒中、血栓栓塞及死亡）危险因素的校正风险比。
共纳入1286例AF患者（男性占78.30%；平均年龄74.50岁；阵发性AF占94.48%），中位随访时间为2.1年（四分位间距：1.5 - 2.9年）。总体而言，159例患者死亡。共发生84例卒中及35例血栓栓塞事件。多因素分析显示，超重（25.0≤BMI<30.0 kg/m²）及年龄≥75岁是缺血性卒中的独立危险因素（均P<0.01）。肥胖（BMI≥30.0 kg/m²）、年龄≥75岁、持续性/永久性AF及既往血栓栓塞是血栓栓塞的独立危险因素（均P<0.05）。体重过低（BMI<18.5 kg/m²）、年龄≥75岁、既往缺血性卒中/短暂性脑缺血发作、肾功能不全及心力衰竭是全因死亡的独立危险因素（均P<0.05）。
超重或肥胖可能是AF患者发生缺血性卒中和血栓栓塞的危险因素。体重过低与全因死亡率增加显著相关。
