Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora Research Institute, Aurora Health Care, Aurora University of Wisconsin Medical Group, Milwaukee, WI, USA.
Aurora Cardiovascular Services, Aurora Sinai/ Aurora St Luke's Medical Centers, Milwaukee, WI, USA.
Int J Obes (Lond). 2018 Feb;42(2):169-174. doi: 10.1038/ijo.2017.211. Epub 2017 Aug 30.
Higher body mass index (BMI) is associated with greater prevalence of cardiovascular risk factors, yet an inverse relationship between obesity and survival after cardiovascular events has been described. It is unclear whether a similar relationship exists for patients with implantable cardioverter defibrillators (ICDs) at high risk for mortality. We aimed to assess the impact of BMI on mortality and cardiovascular hospitalization in patients with ICD.
Patients who underwent ICD implantation in 2010-2011 were divided into normal (<25 kg m), overweight (25-29.9 kg m) and obese (⩾30 kg m) groups based on BMI. Clinical parameters were compared and long-term outcomes were determined using χ test, Wilcoxon's rank-sum test, logistic regression models and Kaplan-Meier curves.
Of 904 patients (mean age 67±13 years), 26% had normal BMI, 32% were overweight and 42% were obese. No significant baseline differences in ventricular ejection fraction, ICD for primary or secondary prevention, history of heart failure, syncope or cardiac arrest existed. Despite a greater prevalence of diabetes, hypertension and prior myocardial infarction, the obese and overweight groups had lower mortality (10.1% and 7.9%, respectively) than the normal group (22.9%, P<0.001). On multivariate logistic regression, BMI in the obese and overweight range (odds ratio (OR): 0.35; 95% confidence interval (CI): 0.21-0.58 and OR: 0.25; 95% CI: 0.13-0.40, respectively) was protective against mortality, whereas history of diabetes (OR: 2.01; 95% CI: 1.30-3.09), myocardial infarction (OR: 1.76; 95% CI: 1.11-2.80), heart failure (OR: 3.88; 95% CI: 1.56-9.66), stroke (OR: 3.19; 95% CI: 1.63-6.23) and history of cardiac arrest (OR: 2.65; 95% CI: 1.37-5.15) were independent risk factors for higher mortality.
A paradoxical relationship between BMI and mortality risk is present in elderly patients with ICD at high risk of sudden death with a lower mortality in obese or overweight patients than in those with normal BMI.
较高的体重指数（BMI）与心血管危险因素的患病率较高相关，但已描述肥胖与心血管事件后生存之间呈反比关系。对于植入式心脏复律除颤器（ICD）的高死亡率患者，是否存在类似的关系尚不清楚。我们旨在评估 BMI 对 ICD 患者死亡率和心血管住院的影响。
根据 BMI 将 2010-2011 年接受 ICD 植入的患者分为正常（<25kg/m）、超重（25-29.9kg/m）和肥胖（⩾30kg/m）组。比较临床参数，并使用卡方检验、Wilcoxon 秩和检验、逻辑回归模型和 Kaplan-Meier 曲线确定长期结局。
在 904 例患者（平均年龄 67±13 岁）中，26%的患者 BMI 正常，32%的患者超重，42%的患者肥胖。心室射血分数、ICD 用于一级或二级预防、心力衰竭史、晕厥或心搏骤停等基线差异无统计学意义。尽管糖尿病、高血压和既往心肌梗死的患病率较高，但肥胖组和超重组的死亡率（分别为 10.1%和 7.9%）低于正常组（22.9%，P<0.001）。多变量逻辑回归显示，肥胖和超重范围的 BMI（比值比（OR）：0.35；95%置信区间（CI）：0.21-0.58 和 OR：0.25；95%CI：0.13-0.40）是死亡率的保护因素，而糖尿病史（OR：2.01；95%CI：1.30-3.09）、心肌梗死（OR：1.76；95%CI：1.11-2.80）、心力衰竭（OR：3.88；95%CI：1.56-9.66）、中风（OR：3.19；95%CI：1.63-6.23）和心搏骤停史（OR：2.65；95%CI：1.37-5.15）是更高死亡率的独立危险因素。
在植入 ICD 的高危猝死老年患者中，BMI 与死亡率风险之间存在矛盾关系，肥胖或超重患者的死亡率低于 BMI 正常患者。
