Hira Ravi S, Kataruka Akash, Akeroyd Julia M, Ramsey David J, Pokharel Yashashwi, Gurm Hitinder S, Nasir Khurram, Deswal Anita, Jneid Hani, Alam Mahboob, Ballantyne Christie M, Petersen Laura A, Virani Salim S
University of Washington, Seattle (R.S.H., A.K.).
Health Policy, Quality and Informatics Program, Michael E. DeBakey Veteran Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX (J.M.A., L.A.P., S.S.V.).
Circ Cardiovasc Qual Outcomes. 2019 Jan;12(1):e004817. doi: 10.1161/CIRCOUTCOMES.118.004817.
Obesity is a growing epidemic that has been linked to the development of cardiovascular disease (CVD). Guideline-directed medications for secondary prevention and risk factor control are recommended for patients with all forms of CVD. The association of body mass index (BMI) with use of medications for secondary prevention and risk factor control in patients with CVD are poorly understood.
We identified 1 122 567 patients with CVD receiving care in 130 Veterans Affairs facilities from October 1, 2013, to September 30, 2014. Five groups were stratified by BMI-underweight (BMI, <18.5 kg/m), normal (BMI, 18.5-24.9 kg/m), overweight (BMI, 25-29.9 kg/m), obese (BMI, 30-39.9 kg/m), and extremely obese (BMI, ≥40 kg/m). A composite of 4 measures-blood pressure <140/90 mm Hg, hemoglobin A1c ≤9% in diabetic patients, statin use, and antiplatelet use-termed optimal medial therapy (OMT) was compared among groups. Multivariable logistic regression was performed with normal BMI as the referent category. Underweight patients comprised 12 623 (1.1%), normal BMI 230 471 (20.5%), overweight 413 590 (36.8%), obese 404 105 (36%), and extremely obese 61 778 (5.5%) of the cohort. Only 43.7% of the entire cohort received OMT, and this was the highest in the overweight group. Adjusted odds ratios for receiving OMT were 0.81 (95% CI, 0.77-0.85), 1.11 (95% CI, 1.10-1.13), 1.08 (95% CI, 1.06-1.09), and 0.87 (95% CI, 0.85-0.89), for patients who were underweight, overweight, obese, and extremely obese, respectively, compared with normal BMI.
OMT was low in the entire cohort. There is an inverse U-shaped relationship between OMT and BMI with patients who are underweight and extremely obese less likely to receive OMT compared with patients with normal BMI.
肥胖是一种日益流行的疾病，与心血管疾病（CVD）的发生有关。对于所有形式的CVD患者，推荐使用指南指导的药物进行二级预防和危险因素控制。体重指数（BMI）与CVD患者二级预防和危险因素控制药物使用之间的关联尚不清楚。
我们确定了2013年10月1日至2014年9月30日期间在130家退伍军人事务机构接受治疗的1122567例CVD患者。根据BMI将患者分为五组：体重过轻（BMI<18.5kg/m²）、正常（BMI 18.5-24.9kg/m²）、超重（BMI 25-29.9kg/m²）、肥胖（BMI 30-39.9kg/m²）和极度肥胖（BMI≥40kg/m²）。比较了五组患者中血压<140/90mmHg、糖尿病患者糖化血红蛋白≤9%、使用他汀类药物和使用抗血小板药物这4项指标组成的综合指标，即最佳药物治疗（OMT）的情况。以正常BMI组作为参照类别进行多变量逻辑回归分析。该队列中体重过轻的患者有12623例（1.1%），正常BMI的患者有230471例（20.5%），超重的患者有4
