Diaz Alejandro A, Young Tom P, Kurugol Sila, Eckbo Erick, Muralidhar Nina, Chapman Joshua K, Kinney Gregory L, Ross James C, San Jose Estepar Raul, Harmouche Rola, Black-Shinn Jennifer L, Budoff Matthew, Bowler Russell P, Hokanson John, Washko George R
Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Chronic Obstr Pulm Dis. 2015;2(1):8-16. doi: 10.15326/jcopdf.2.1.2014.0127.
Cardiovascular diseases are frequent and a major cause of death in patients with chronic obstructive pulmonary disease (COPD). In the general population, various fat depots including abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver fat have been linked to increased risk of cardiovascular diseases. We hypothesize that these adipose tissue compartments are associated with myocardial infarction (MI) in patients with COPD.
We collected measures of VAT and SAT areas and liver attenuation on the computed tomography scan of the chest from 1267 patients with COPD. MI was a self-reported physician-diagnosed outcome. The association between fat depots and self-reported history of MI was assessed by logistic regression analysis in which the patients within the 2 lowest tertiles of VAT and SAT areas were the reference group.
Eighty three patients (6.6%) reported a history of MI at the time of enrollment. Compared to patients who did not have an MI episode, those who had a prior MI had a higher VAT area (mean ± SD, 303.4 ± 208.5 vs. 226.8 ± 172.6 cm; P=0.002) with no differences in SAT area and liver fat. After adjustment for age, gender, obesity, pack years of smoking, hypertension, high cholesterol, and diabetes, patients within the upper tertile (vs. those in the lower tertiles) of VAT area had increased odds of MI (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.02 - 3.41).
Increased abdominal visceral fat is independently associated with a history of MI in individuals with COPD.
心血管疾病在慢性阻塞性肺疾病（COPD）患者中很常见，是导致患者死亡的主要原因。在普通人群中，包括腹部内脏脂肪组织（VAT）、皮下脂肪组织（SAT）和肝脏脂肪在内的各种脂肪储存部位都与心血管疾病风险增加有关。我们假设这些脂肪组织区域与COPD患者的心肌梗死（MI）有关。
我们收集了1267例COPD患者胸部计算机断层扫描中VAT和SAT面积以及肝脏衰减的测量数据。MI是自我报告的医生诊断结果。通过逻辑回归分析评估脂肪储存部位与自我报告的MI病史之间的关联，其中VAT和SAT面积处于最低三分位数的患者为参照组。
83例患者（6.6%）在入组时报告有MI病史。与没有MI发作的患者相比，有既往MI的患者VAT面积更大（均值±标准差，303.4±208.5 vs. 226.8±172.6 cm；P = 0.002），而SAT面积和肝脏脂肪无差异。在调整年龄、性别、肥胖、吸烟包年数、高血压、高胆固醇和糖尿病后，VAT面积处于最高三分位数的患者（与最低三分位数的患者相比）发生MI的几率增加（优势比[OR] 1.86，95%置信区间[CI] 1.02 - 3.41）。
腹部内脏脂肪增加与COPD患者的MI病史独立相关。
