Lamelas Pablo, Schwalm Jon-David, Quazi Ibrahim, Mehta Shamir, Devereaux P J, Jolly Sanjit, Yusuf Salim
The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada.
The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada.
Am J Cardiol. 2017 Nov 1;120(9):1453-1459. doi: 10.1016/j.amjcard.2017.07.043. Epub 2017 Jul 29.
The association between body mass index (BMI) and major clinical events after acute coronary syndrome (ACS) remains controversial. We investigated the impact of BMI on major clinical events after ACS in a large individual patient data meta-analysis. Data on 81,553 patients from 45 different countries with ACS enrolled in 8 large randomized clinical trials were included, followed up for a median of 171 days. The mean age was 63.4 ± 11.7, 70% were male, and the mean BMI was 27.3 ± 4.7 kg/m. Compared with upper-normal-weight participants (BMI 21.75 to 24.9 kg/m, reference category), underweight participants (<18.5 kg/m) had an increased risk of death (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.10 to 1.66, p = 0.004). Both overweight subcategories, BMI 25 to 27.5 kg/m (HR 0.81, 95% CI 0.75 to 0.89, p <0.001) and BMI 27.5 to 29.9 kg/m (HR 0.84, 95% CI 0.76 to 0.92, p <0.001), and type I obesity (30 to 34.9, HR 0.81, 95% CI 0.73 to 0.89, p <0.001) had a significantly lower mortality. Type II and III obesities were not significantly associated with mortality. Mortality was lowest at a BMI of 30.9 kg/m. Compared with normal-weight patients, overweight and obese categories were related with a significantly lower risk of bleeding and refractory ischemia. Overweight patients had a lower risk of myocardial infarction, heart failure hospitalizations, and heart failure-related deaths. There were no associations between BMI and revascularization rates or stroke. In conclusion, underweight and normal-weight patients were associated with an increased mortality risk, bleeding, ischemia, and heart failure compared with those with higher BMI after ACS.
体重指数（BMI）与急性冠状动脉综合征（ACS）后主要临床事件之间的关联仍存在争议。我们在一项大型个体患者数据荟萃分析中研究了BMI对ACS后主要临床事件的影响。纳入了来自45个不同国家的81553例ACS患者的数据，这些患者参与了8项大型随机临床试验，中位随访时间为171天。平均年龄为63.4±11.7岁，70%为男性，平均BMI为27.3±4.7kg/m²。与体重正常偏高的参与者（BMI为21.75至24.9kg/m²，参考类别）相比，体重过轻的参与者（<18.5kg/m²）死亡风险增加（风险比[HR]为1.35，95%置信区间[CI]为1.10至1.66，p = 0.004）。两个超重亚组，即BMI为25至27.5kg/m²（HR为0.81，95%CI为0.75至0.89，p<0.001）和BMI为27.5至29.9kg/m²（HR为0.84，95%CI为0.76至0.92，p<0.001），以及I型肥胖（30至34.9，HR为0.81，95%CI为0.73至0.89，p<0.001）的死亡率均显著较低。II型和III型肥胖与死亡率无显著关联。BMI为30.9kg/m²时死亡率最低。与体重正常的患者相比，超重和肥胖类别与出血和难治性缺血风险显著较低相关。超重患者发生心肌梗死、心力衰竭住院和心力衰竭相关死亡的风险较低。BMI与血运重建率或中风之间无关联。总之，与ACS后BMI较高的患者相比，体重过轻和体重正常的患者死亡风险增加，且有出血、缺血和心力衰竭的情况。
