体重指数与射血分数正常和降低的心衰患者的全因死亡率：剂量反应荟萃分析。
Body mass index and all-cause mortality in heart failure patients with normal and reduced ventricular ejection fraction: a dose-response meta-analysis.
机构信息
Faculty of Medical Science, School of Medicine, Anglia Ruskin University, Michael Salmon Building, Bishop Hall Lane, Chelmsford, CM1 1SQ, UK.
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
出版信息
Clin Res Cardiol. 2019 Feb;108(2):119-132. doi: 10.1007/s00392-018-1302-7. Epub 2018 Jun 27.
BACKGROUND
For patients with heart failure, there is an inverse relation between body mass index (BMI) and mortality, sometimes called the obesity-paradox. However, the relationship might be either U- or J-shaped and might differ between patients with reduced (HFrEF) or preserved left ventricular ejection fraction (HFpEF). We sought to investigate this further in a dose-response meta-analysis of published studies.
METHODS
PubMed and Embase from June 1980 to April 2017 were searched for prospective cohort studies evaluating associations between BMI and all-cause mortality in patients with HFrEF (LVEF < 40%) or HFpEF (LVEF ≥ 50%). Summary estimated effect sizes were obtained by using a random-effects model. Potential non-linear relationships were evaluated by using random-effects restricted cubic spline models.
RESULTS
Ten studies were identified that included 96,424 patients of whom 59,263 had HFpEF (mean age 68 years of whom 38% were women) and 37,161 had HFrEF (mean age 60 years of whom 17% were women). For patients with HFpEF, the summary hazard ratio (HR) for all-cause mortality was: 0.93 (95% CI 0.89-0.97) per 5 units increase in BMI (I = 75.8%, p for heterogeneity = 0.01 and Begg's test, p = 1.0, Egger's test, p = 0.29) but the association was U-shaped (p for non-linearity < 0.01) with the nadir of risk at a BMI of 32-33 kg/m. For patients with HFrEF, the summary HR for all-cause mortality was: 0.96 (95% CI 0.92-0.99) (I = 95%, p for heterogeneity < 0.001 and Begg's test, p = 0.45, Egger's test, p = 0.01). The relationship was also U-shaped (p < 0.01), although 'flatter' than for HFpEF, with the nadir at a BMI of 33 kg/m.
CONCLUSIONS
For patients with heart failure, the relation between BMI and mortality is U-shaped with a similar nadir of risk for HFpEF and HFrEF at a BMI of 32-33 kg/m. Whether interventions that alter weight in either direction can alter risk is unknown.
背景
对于心力衰竭患者，体重指数（BMI）与死亡率之间呈反比关系，有时被称为肥胖悖论。然而，这种关系可能是 U 形或 J 形的，并且在射血分数降低的心力衰竭（HFrEF）或射血分数保留的心力衰竭（HFpEF）患者之间可能存在差异。我们试图通过对已发表研究的剂量反应荟萃分析进一步研究这一关系。
方法
从 1980 年 6 月至 2017 年 4 月，我们在 PubMed 和 Embase 上搜索了评估 BMI 与 HFrEF（LVEF<40%）或 HFpEF（LVEF≥50%）患者全因死亡率之间关系的前瞻性队列研究。使用随机效应模型获得汇总估计效应大小。使用随机效应限制立方样条模型评估潜在的非线性关系。
结果
确定了 10 项研究，其中包括 96424 名患者，其中 59263 名患有 HFpEF（平均年龄 68 岁，其中 38%为女性），37161 名患有 HFrEF（平均年龄 60 岁，其中 17%为女性）。对于 HFpEF 患者，全因死亡率的汇总危险比（HR）为：BMI 每增加 5 个单位，HR 为 0.93（95%CI 0.89-0.97）（I=75.8%，p 异质性=0.01，Begg 检验，p=1.0，Egger 检验，p=0.29），但这种关系呈 U 形（p<0.01），风险最低点出现在 BMI 为 32-33kg/m 时。对于 HFrEF 患者，全因死亡率的汇总 HR 为：0.96（95%CI 0.92-0.99）（I=95%，p 异质性<0.001，Begg 检验，p=0.45，Egger 检验，p=0.01）。这种关系也是 U 形的（p<0.01），尽管与 HFpEF 相比，这种关系“更平坦”，风险最低点出现在 BMI 为 33kg/m 时。
结论
对于心力衰竭患者，BMI 与死亡率之间的关系呈 U 形，HFpEF 和 HFrEF 的风险最低点在 BMI 为 32-33kg/m 时相似。尚不清楚改变体重方向的干预措施是否会改变风险。
Zotero 插件