Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, 75390 Texas, USA.
Duke Clinical Research Institute, 2400 Pratt Street, Durham, 27705 North Carolina, USA.
Eur Heart J Qual Care Clin Outcomes. 2017 Jul 1;3(3):183-191. doi: 10.1093/ehjqcco/qcx010.
To investigate the obesity paradox and association of extreme obesity with long-term outcomes among older ST-segment elevation myocardial infarction (STEMI) patients.
Nineteen thousand four hundred and ninety-nine patients ≥65 years with STEMI surviving to hospital discharge in NCDR ACTION Registry-GWTG linked to Centers for Medicare and Medicaid Services outcomes between 2007 and 2012 were stratified by body mass index (BMI) (kg/m2) into normal weight (18.5-24.9), overweight (25-29.9), class I (30-34.9), class II (35-39.9), and class III/extreme obese (≥40) categories. Multivariable-adjusted associations were evaluated between BMI categories and mortality by Cox proportional hazards models, and days alive and out of hospital (DAOH) by generalized estimating equations, within 3 years after discharge. Seventy percent of patients were overweight/obese and 3% extremely obese. Normal weight patients were older and more likely to smoke; while extremely obese patients were younger and more likely to be female and black, with lower socioeconomic status and more comorbidity (P ≤ 0.001). A U-shaped association was observed between BMI categories and mortality: patients with class I obesity were at lowest risk, while normal weight [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.15-1.47] and extremely obese patients (HR 1.33, 95% CI 1.02-1.74) had higher mortality. Normal weight [odds ratio (OR) 0.79, 95% CI 0.68-0.90] and extremely obese (OR 0.73, 95% CI 0.54-0.99) individuals also had lower odds of DAOH.
Mild obesity is associated with lower long-term risk in older STEMI patients, while normal weight and extreme obesity are associated with worse outcomes. These findings highlight hazards faced by an increasing number of older individuals with normal weight or extreme obesity and cardiovascular disease.
调查肥胖悖论以及极重度肥胖与老年 ST 段抬高型心肌梗死（STEMI）患者长期预后的相关性。
在 NCDR ACTION 注册研究-GWTG 中，对 2007 年至 2012 年期间与医疗保险和医疗补助服务机构（Centers for Medicare and Medicaid Services）结果相关联、出院时存活的 19499 例年龄≥65 岁的 STEMI 患者，按体重指数（BMI）（kg/m2）进行分层，分为正常体重（18.5-24.9）、超重（25-29.9）、I 级肥胖（30-34.9）、II 级肥胖（35-39.9）和 III/极重度肥胖（≥40）。采用 Cox 比例风险模型评估 BMI 类别与 3 年内死亡率之间的多变量校正关联，采用广义估计方程评估出院后 3 年内的存活天数和院外天数（DAOH）。70%的患者超重/肥胖，3%的患者极重度肥胖。正常体重患者年龄较大，更可能吸烟；而极重度肥胖患者更年轻，更可能为女性和黑人，社会经济地位较低，合并症更多（P≤0.001）。BMI 类别与死亡率之间呈 U 型关联：I 级肥胖患者风险最低，而正常体重患者（HR 1.30，95%置信区间 1.15-1.47）和极重度肥胖患者（HR 1.33，95%置信区间 1.02-1.74）死亡率更高。正常体重（OR 0.79，95%置信区间 0.68-0.90）和极重度肥胖（OR 0.73，95%置信区间 0.54-0.99）患者的 DAOH 几率也较低。
在老年 STEMI 患者中，轻度肥胖与较低的长期风险相关，而正常体重和极重度肥胖与较差的预后相关。这些发现强调了越来越多的正常体重或极重度肥胖且患有心血管疾病的老年个体所面临的风险。
