1 Kanta-Häme Central Hospital, Finland.
2 Medical School, University of Tampere, Finland.
Eur Heart J Acute Cardiovasc Care. 2017 Dec;6(8):771-777. doi: 10.1177/2048872616633844. Epub 2016 Feb 24.
Although obesity is a risk factor for coronary heart disease (CHD), it might be associated with a favourable prognosis in patients with CHD. The aim of the study was to evaluate this so called 'obesity paradox' during a follow-up period of 20 years in patients who had undergone coronary artery bypass grafting (CABG).
The study population consisted of 922 CHD patients who had undergone CABG between 1993 and 1994. Pre and perioperative data was collected from patient records and supplemented with patient questionnaires, telephone contacts and data from national archives. The 10-year postoperative prognosis of normal-weight patients (body mass index (BMI) 18.5-24.9 kg/m) was inferior to that of overweight (BMI 25.0-29.9 kg/m) and obese patients (BMI⩾30.0 kg/m) and to the background population. Beyond 10 years the prognosis of obese patients deteriorated when compared with the overweight group. At the end of the 20-year follow-up, survival of the normal weight group was 0.68 (95% confidence interval (CI), 0.49-0.87; p<0.001), the overweight group 0.82 (95% CI, 0.71-0.92; p<0.001), and the obese group 0.67 (95% CI, 0.49-0.85; p<0.001), when compared with their background populations (=1.00). Obese patients developed diabetes more frequently and died more frequently of cardiovascular disease than patients in the two other study groups during the second postoperative decade ( p<0.01).
During long-term follow-up the obesity paradox seems to disappear due to progression of cardiometabolic disease in patients who have undergone CABG.
虽然肥胖是冠心病（CHD）的一个危险因素，但它可能与 CHD 患者的良好预后相关。本研究的目的是在接受冠状动脉旁路移植术（CABG）的患者中，在 20 年的随访期间评估这种所谓的“肥胖悖论”。
该研究人群包括 1993 年至 1994 年间接受 CABG 的 922 名 CHD 患者。从患者记录中收集术前和围手术期数据，并通过患者问卷调查、电话联系和国家档案中的数据进行补充。正常体重患者（体重指数（BMI）18.5-24.9 kg/m）的 10 年术后预后不如超重患者（BMI 25.0-29.9 kg/m）和肥胖患者（BMI ⩾30.0 kg/m）和背景人群。超过 10 年后，与超重组相比，肥胖组的预后恶化。在 20 年随访结束时，正常体重组的生存率为 0.68（95%置信区间（CI），0.49-0.87；p<0.001），超重组为 0.82（95% CI，0.71-0.92；p<0.001），肥胖组为 0.67（95% CI，0.49-0.85；p<0.001），与他们的背景人群（=1.00）相比。在术后的第二个十年中，与其他两组患者相比，肥胖患者更频繁地发生糖尿病，并更多地死于心血管疾病（p<0.01）。
在长期随访中，由于接受 CABG 的患者代谢性疾病的进展，肥胖悖论似乎消失了。
