From the New York University School of Medicine (S.B.), Pfizer (R.F., R.L., D.A.D.), and the Mount Sinai Icahn School of Medicine (F.H.M.) - all in New York; University Hospital, Bern, Switzerland (F.H.M.); Jagiellonian University, Krakow, Poland (F.H.M.); and San Francisco General Hospital, San Francisco (D.D.W.).
N Engl J Med. 2017 Apr 6;376(14):1332-1340. doi: 10.1056/NEJMoa1606148.
Body-weight fluctuation is a risk factor for death and coronary events in patients without cardiovascular disease. It is not known whether variability in body weight affects outcomes in patients with coronary artery disease.
We determined intraindividual fluctuations in body weight from baseline weight and follow-up visits and performed a post hoc analysis of the Treating to New Targets trial, which involved assessment of the efficacy and safety of lowering low-density lipoprotein cholesterol levels with atorvastatin. The primary outcome was any coronary event (a composite of death from coronary heart disease, nonfatal myocardial infarction, resuscitated cardiac arrest, revascularization, or angina). Secondary outcomes were any cardiovascular event (a composite of any coronary event, a cerebrovascular event, peripheral vascular disease, or heart failure), death, myocardial infarction, or stroke.
Among 9509 participants, after adjustment for risk factors, baseline lipid levels, mean body weight, and weight change, each increase of 1 SD in body-weight variability (measured according to average successive variability and used as a time-dependent covariate) was associated with an increase in the risk of any coronary event (2091 events; hazard ratio, 1.04; 95% confidence interval [CI], 1.01 to 1.07; P=0.01), any cardiovascular event (2727 events; hazard ratio, 1.04; 95% CI, 1.02 to 1.07; P<0.001), and death (487 events; hazard ratio,1.09; 95% CI, 1.07 to 1.12; P<0.001). Among patients in the quintile with the highest variation in body weight, the risk of a coronary event was 64% higher, the risk of a cardiovascular event 85% higher, death 124% higher, myocardial infarction 117% higher, and stroke 136% higher than it was among those in the quintile with the lowest variation in body weight in adjusted models.
Among participants with coronary artery disease, fluctuation in body weight was associated with higher mortality and a higher rate of cardiovascular events independent of traditional cardiovascular risk factors. (Funded by Pfizer; ClinicalTrials.gov number, NCT00327691 .).
体重波动是无心血管疾病患者死亡和冠心病事件的危险因素。目前尚不清楚体重变化是否会影响冠心病患者的预后。
我们根据基线体重和随访时的体重，确定个体内体重波动，并对降脂治疗达新目标（Treating to New Targets）试验进行了事后分析，该试验评估了阿托伐他汀降低低密度脂蛋白胆固醇水平的疗效和安全性。主要终点是任何冠心病事件（由冠心病死亡、非致死性心肌梗死、复苏性心脏骤停、血运重建或心绞痛组成的复合终点）。次要终点是任何心血管事件（由任何冠心病事件、脑血管事件、外周血管疾病或心力衰竭组成的复合终点）、死亡、心肌梗死或卒中等。
在 9509 名参与者中，在调整了危险因素、基线血脂水平、平均体重和体重变化后，体重波动的每增加 1 个标准差（根据平均连续变异性测量，作为时变协变量）与任何冠心病事件（2091 例事件；风险比，1.04；95%置信区间[CI]，1.01 至 1.07；P=0.01）、任何心血管事件（2727 例事件；风险比，1.04；95%CI，1.02 至 1.07；P<0.001）和死亡（487 例事件；风险比，1.09；95%CI，1.07 至 1.12；P<0.001）的风险增加相关。在体重变化最大的五分位组中，冠心病事件的风险增加 64%，心血管事件的风险增加 85%，死亡的风险增加 124%，心肌梗死的风险增加 117%，卒中的风险增加 136%，而在体重变化最小的五分位组中，这些风险均较低。在调整后的模型中。
在患有冠心病的参与者中，体重波动与更高的死亡率和更高的心血管事件发生率相关，独立于传统心血管危险因素。（由辉瑞公司资助；ClinicalTrials.gov 编号，NCT00327691）。
