Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
J Cardiol. 2018 Sep;72(3):208-214. doi: 10.1016/j.jjcc.2018.02.007. Epub 2018 Mar 14.
The prognostic long-term impact of body mass index (BMI) on East Asian patients with coronary artery disease remains unclear.
An observational retrospective cohort study was carried out involving 3571 patients who had undergone percutaneous coronary intervention (PCI) from 2000 to 2013. Patients were divided into the following five groups according to baseline BMI: Group 1 (underweight 1, BMI ≤20.0kg/m); Group 2 (underweight 2, BMI=20.1-22.5kg/m); Group 3 (normal weight, BMI=22.6-25.0kg/m); Group 4 (overweight 1, BMI=25.1-27.5kg/m); and Group 5 (overweight 2, BMI ≥27.6kg/m). We then evaluated the association between BMI and both all-cause and cardiac death after PCI.
The ratio of patients in the five groups was as follows: Group 1, 9.2%; Group 2, 21.6%; Group 3, 34.1%; Group 4, 21.1%; and Group 5, 14.5%. A decrease in age was observed from underweight to overweight, as was an increased prevalence of hypertension, diabetes mellitus, dyslipidemia, and smoking. The median follow-up period was 6.3 years (interquartile range, 3.2-9.6 years). In total, 473 deaths (frequency, 13.2%) were identified, including 183 (5.1%) cardiac deaths during follow-up. In unadjusted Cox proportional hazard analysis, using normal weight as the reference, underweight, but not overweight, was associated with a greater risk of both all-cause and cardiac death. In an adjusted model, Group 1 had the highest risk for all-cause death (hazard ratio, 1.58; 95% confidence interval, 1.19-2.10; p=0.0019); however, no significant differences were found for the risk of all-cause and cardiac death between normal weight and overweight patients.
The results of the present long-term follow-up study do not support the so-called "obesity paradox," but rather, suggest that underweight Japanese patients are at greater risk for all-cause mortality following PCI.
体质量指数（BMI）对东亚冠心病患者的长期预后影响尚不清楚。
对 2000 年至 2013 年间行经皮冠状动脉介入治疗（PCI）的 3571 例患者进行了一项观察性回顾性队列研究。根据基线 BMI 将患者分为以下五组：第 1 组（体重不足 1 组，BMI≤20.0kg/m）；第 2 组（体重不足 2 组，BMI=20.1-22.5kg/m）；第 3 组（正常体重组，BMI=22.6-25.0kg/m）；第 4 组（超重 1 组，BMI=25.1-27.5kg/m）；第 5 组（超重 2 组，BMI≥27.6kg/m）。然后评估了 BMI 与 PCI 后全因死亡和心脏死亡之间的关系。
五组患者的比例分别为：第 1 组 9.2%；第 2 组 21.6%；第 3 组 34.1%；第 4 组 21.1%；第 5 组 14.5%。体重不足组到超重组年龄逐渐下降，高血压、糖尿病、血脂异常和吸烟的患病率也逐渐增加。中位随访时间为 6.3 年（四分位距，3.2-9.6 年）。共有 473 例患者（频率 13.2%）死亡，其中 183 例（5.1%）为心脏死亡。在未经调整的 Cox 比例风险分析中，以正常体重为参考，体重不足而非超重与全因和心脏死亡风险增加相关。在调整后的模型中，第 1 组全因死亡风险最高（风险比，1.58；95%置信区间，1.19-2.10；p=0.0019）；然而，正常体重和超重患者的全因和心脏死亡风险无显著差异。
本长期随访研究结果不支持所谓的“肥胖悖论”，而是提示日本体重不足的患者行 PCI 后全因死亡率更高。
