Abi Khalil Charbel, Sulaiman Kadhim, Singh Rajvir, Jayyousi Amin, Asaad Nidal, AlHabib Khalid F, Alsheikh-Ali Alawi, Al-Jarallah Mohammed, Bulbanat Bassam, AlMahmeed Wael, Dargham Soha, Ridha Mustafa, Bazargani Nooshin, Amin Haitham, Al-Motarreb Ahmed, AlFaleh Husam, Elasfar Abdelfatah, Panduranga Prashanth, Al Suwaidi Jassim
Department of Medicine, Weill Cornell Medicine, Doha, Qatar; Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar; Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
National Heart Center, Royal Hospital, Muscat, Oman.
Int J Cardiol. 2017 Aug 15;241:262-269. doi: 10.1016/j.ijcard.2017.02.119. Epub 2017 Feb 27.
A U-shaped relationship has been reported between BMI and cardiovascular events among patients with acute heart failure (AHF). We hypothesized that an obesity paradox also governs the relationship between BMI and mortality in patients with type 2 diabetes (T2D) and AHF.
We studied 3-month and 12-month mortality in patients with T2D hospitalized for AHF according to 5 BMI categories: Underweight (<20kg/m), normal weight (referent group, 20-24.9kg/m), overweight, (25-29.9kg/m), obese (30-34.9kg/m) and severely obese (≥35kg/m), in the Gulf aCute heArt failuRe rEgistry (GULF-CARE).
Among the 5005 participants in this cohort, 2492 (49.8%) had T2D. Underweight patients had a higher 3-month and 12-month mortality risk (OR 2.04, 95% CI [1.02-4.08]; OR 2.44, 95% CI [1.35-4.3]; respectively), compared to normal weight. Severe obesity was associated with a lower 3-month and 12-month mortality risk (OR 0.53, 95% CI [0.34-0.83]; OR 0.58, 95% CI [0.42-0.81]; respectively). After adjustment for several risk variables in 2 different models, the primary outcome was still significantly increased in underweight patients, and decreased in severely obese patients, at 3months and 12months. Further, the odds of mortality decreases with increasing BMI by 0.38 at 3months and at 0.45 at 12months in a near-linear shape (p=0.007; p=0.037; respectively).
In this cohort of patients with AHF, BMI was inversely correlated to the risk of mortality in patients with T2D. Moreover, severe obesity was associated with less mortality risk.
急性心力衰竭（AHF）患者中，体重指数（BMI）与心血管事件之间呈U型关系。我们推测肥胖悖论也适用于2型糖尿病（T2D）合并AHF患者中BMI与死亡率之间的关系。
我们在海湾急性心力衰竭注册研究（GULF-CARE）中，根据5种BMI类别，研究了因AHF住院的T2D患者3个月和12个月的死亡率：体重过轻（<20kg/m）、正常体重（参照组，20-24.9kg/m）、超重（25-29.9kg/m）、肥胖（30-34.9kg/m）和重度肥胖（≥35kg/m）。
在该队列的5005名参与者中，2492名（49.8%）患有T2D。与正常体重患者相比，体重过轻的患者3个月和12个月的死亡风险更高（分别为OR 2.04，95%CI[1.02-4.08]；OR 2.44，95%CI[1.35-4.3]）。重度肥胖与较低的3个月和12个月死亡风险相关（分别为OR 0.53，95%CI[0.34-0.83]；OR 0.58，95%CI[0.42-0.81]）。在两种不同模型中对多个风险变量进行调整后，体重过轻的患者在3个月和12个月时的主要结局仍显著增加，而重度肥胖患者则降低。此外，在3个月时，死亡率的比值随BMI增加以近线性方式降低0.38，在12个月时降低0.45（分别为p=0.007；p=0.037）。
在该AHF患者队列中，BMI与T2D患者的死亡风险呈负相关。此外，重度肥胖与较低的死亡风险相关。
