Che Lu, Xu Li, Wang Ming-Ya, Huang Yu-Guang
Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China.
Department of Anesthesiology, State Key Laboratory of Translational Cardiovascular Medicine, Fuwai Hospital & Cardiovascular Institute, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China.
J Geriatr Cardiol. 2018 Sep 28;15(9):598-604. doi: 10.11909/j.issn.1671-5411.2018.09.004.
High body mass index (BMI) is a risk factor for chronic cardiac disease. However, mounting evidence supports that high BMI is associated with less risk of cardiac morbidity and mortality compared with normal BMI, also known as the obesity paradox. Therefore, we sought to determine the existence of the obesity paradox in regard to perioperative 30-day cardiac events among elderly Chinese patients with known coronary artery disease undergoing non-cardiac surgery.
A post-hoc analysis of a prospective, multi-institutional cohort study was performed. Patients aged > 60 years with a history of coronary artery disease and undergoing non-cardiac surgery were grouped according to BMI: underweight (< 18.5 kg/m), normal weight (18.5-24.9 kg/m), overweight (25-29.9 kg/m) and obese (≥ 30 kg/m). Demographic information, perioperative clinical variables and incidence of 30-day postoperative cardiac adverse event were retrieved from a research database.
We identified 1202 eligible patients (BMI: 24.3 ± 3.8 kg/m). Across BMI groups, a U-shaped distribution pattern of incidence of 30-day postoperative major cardiac events was observed, with the lowest risk in the overweight group. When using the normal-weight group as a reference, no difference was found in either the obesity or overweight groups in terms of a major cardiac adverse event (MACE). However, risk of a 30-day postoperative MACE was significantly higher in the underweight group (odds ratio [OR] 2.916, 95% confidence interval [CI]: 1.072-7.931, = 0.036).
Although not statistically significant, the U-shaped relation between BMI and cardiac complications indicates the obesity paradox possibly exists.
高体重指数（BMI）是慢性心脏病的一个危险因素。然而，越来越多的证据支持，与正常BMI（也称为肥胖悖论）相比，高BMI与较低的心脏发病率和死亡率风险相关。因此，我们试图确定在接受非心脏手术的中国老年冠心病患者围手术期30天心脏事件方面是否存在肥胖悖论。
对一项前瞻性、多机构队列研究进行事后分析。将年龄>60岁、有冠心病病史且接受非心脏手术的患者按BMI分组：体重过轻（<18.5kg/m）、正常体重（18.5 - 24.9kg/m）、超重（25 - 29.9kg/m）和肥胖（≥30kg/m）。从研究数据库中检索人口统计学信息、围手术期临床变量和术后30天心脏不良事件的发生率。
我们确定了1202例符合条件的患者（BMI：24.3±3.8kg/m）。在各BMI组中，观察到术后30天主要心脏事件发生率呈U形分布模式，超重组风险最低。以正常体重组为参照，肥胖组和超重组在主要心脏不良事件（MACE）方面均未发现差异。然而，体重过轻组术后30天发生MACE的风险显著更高（比值比[OR]2.916，95%置信区间[CI]：1.072 - 7.931，P = 0.036）。
尽管无统计学意义，但BMI与心脏并发症之间的U形关系表明可能存在肥胖悖论。
