Sharma Saurabh, Batsis John A, Coutinho Thais, Somers Virend K, Hodge David O, Carter Rickey E, Sochor Ondrej, Kragelund Charlotte, Kanaya Alka M, Zeller Marianne, Park Jong-Seon, Køber Lars, Torp-Pedersen Christian, Lopez-Jimenez Francisco
Division of Cardiovascular Diseases, Einstein Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH; Centers for Health and Aging and the Health Promotion Research Center at Dartmouth, Dartmouth College, Hanover, NH.
Mayo Clin Proc. 2016 Mar;91(3):343-51. doi: 10.1016/j.mayocp.2015.12.007. Epub 2016 Feb 6.
To study the relationship between body mass index (BMI) and central obesity and mortality in elderly patients with coronary artery disease (CAD).
We identified 7057 patients 65 years or older from 5 cohort studies assessing mortality risk using either waist circumference (WC) or waist-hip ratio (WHR) in patients with CAD from January 1, 1980, to December 31, 2008. Normal weight, overweight, and obesity were defined using standard BMI cutoffs. High WHR was defined as 0.85 or more for women and 0.90 or more for men. High WC was defined as 88 cm or more for women and 102 cm or more for men. Separate models examined WC or WHR in combination with BMI (6 categories each) as the primary predictor (referent = normal BMI and normal WC or WHR). Cox proportional hazards models investigated the relationship between these obesity categories and mortality.
Patients' mean age was 73.0±6.0 years (3741 [53%] women). The median censor time was 7.1 years. A normal BMI with central obesity (high WHR or high WC) demonstrated highest mortality risk (hazard ratio [HR], 1.29; 95% CI, 1.14-1.46; HR, 1.29; 95% CI, 1.12-1.50, respectively). High WHR was also predictive of mortality in the overall (HR, 2.14; 95% CI, 1.93-2.38) as well as in the sex-specific cohort. In the overall cohort, high WC was not predictive of mortality (HR, 1.04; 95% CI, 0.97-1.12); however, it predicted higher risk in men (HR, 1.12; 95% CI, 1.01-1.24).
In older adults with CAD, normal-weight central obesity defined using either WHR or WC is associated with high mortality risk, highlighting a need to combine measures in adiposity-related risk assessment.
研究老年冠心病（CAD）患者体重指数（BMI）与中心性肥胖及死亡率之间的关系。
我们从5项队列研究中识别出7057例65岁及以上的患者，这些研究在1980年1月1日至2008年12月31日期间，使用腰围（WC）或腰臀比（WHR）评估CAD患者的死亡风险。正常体重、超重和肥胖采用标准BMI临界值进行定义。高WHR定义为女性≥0.85，男性≥0.90。高WC定义为女性≥88 cm，男性≥102 cm。分别构建模型，将WC或WHR与BMI（各6个类别）联合作为主要预测因素（对照=正常BMI且WC或WHR正常）。Cox比例风险模型研究这些肥胖类别与死亡率之间的关系。
患者的平均年龄为73.0±6.0岁（3741例[53%]为女性）。中位随访时间为7.1年。正常BMI合并中心性肥胖（高WHR或高WC）显示出最高的死亡风险（风险比[HR]，1.29；95%置信区间[CI]，1.14 - 1.46；HR，1.29；95% CI，1.12 - 1.50）。高WHR在总体人群（HR，2.14；95% CI，1.93 - 2.38）以及按性别分层的队列中也可预测死亡率。在总体队列中，高WC不能预测死亡率（HR，1.04；95% CI，0.97 - 1.12）；然而，它在男性中预测更高的风险（HR，1.12；95% CI，1.01 - 1.24）。
在老年CAD患者中，使用WHR或WC定义的正常体重中心性肥胖与高死亡风险相关，这突出了在肥胖相关风险评估中需要综合多种测量方法。
