Lamelas Pablo M, Maheer Khan, Schwalm Jon-David
a The Population Health Research Institute , Hamilton , Canada.
Acta Cardiol. 2017 Dec;72(6):655-661. doi: 10.1080/00015385.2017.1320470. Epub 2017 Jun 28.
The association between body mass index (BMI) and mortality after acute coronary syndromes (ACS) is controversial. The objective of this analysis is to summarize the available evidence of this association and perform meta-analysis using adjusted estimates.
Systematic review from MEDLINE and EMBASE through May 2015 was performed. Studies were considered eligible if they described the association between BMI and all-cause mortality after ACS, and those reporting adjusted estimates were included in the meta-analysis. We included 35 articles with 316,455 participants, with overall poor to moderate quality. No study reported that overweight, type-I or type-II obesity was related to an increased risk of mortality compared to normal weight. Pooled adjusted estimates from 18 studies (137,975 participants) showed lower adjusted mortality both overweight (RR: 0.83; 95% CI: 0.75-0.91; p < .001; I 51%) and obese (RR: 0.79; 95% CI: 0.71-0.88; p < .001; I 33%) categories when compared to normal weight. Heterogeneity was not explained in pre-specified subgroups analysis.
Increased BMI was associated with increased adjusted survival after ACS when compared to normal BMI. Unexplained heterogeneity and suboptimal quality of studies limit the strength of the results. This seemingly paradoxical finding needs to be confirmed with further research.
体重指数（BMI）与急性冠脉综合征（ACS）后死亡率之间的关联存在争议。本分析的目的是总结该关联的现有证据，并使用校正估计值进行荟萃分析。
对截至2015年5月的MEDLINE和EMBASE进行系统评价。如果研究描述了BMI与ACS后全因死亡率之间的关联，则认为这些研究符合纳入标准，且报告校正估计值的研究纳入荟萃分析。我们纳入了35篇文章，共316,455名参与者，总体质量从差到中等。没有研究报告超重、I型或II型肥胖与正常体重相比死亡率风险增加有关。来自18项研究（137,975名参与者）的汇总校正估计值显示，与正常体重相比，超重（RR：0.83；95%CI：0.75 - 0.91；p <.001；I² 51%）和肥胖（RR：0.79；95%CI：0.71 - 0.88；p <.001；I² 33%）类别中的校正死亡率较低。在预先指定的亚组分析中未解释异质性。
与正常BMI相比，ACS后BMI升高与校正后生存率增加相关。无法解释的异质性和研究质量欠佳限制了结果的说服力。这一看似矛盾的发现需要进一步研究加以证实。
