Murakawa Yuji, Ikeda Takanori, Ogawa Satoshi, Kitazono Takanari, Nakagawara Jyoji, Minematsu Kazuo, Miyamoto Susumu, Hayashi Yasuhiro, Kidani Yoko, Okayama Yutaka, Sunaya Toshiyuki, Sato Shoichiro, Yamanaka Satoshi
The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital, 5-1-1, Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan.
Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan.
Heart Vessels. 2020 Aug;35(8):1125-1134. doi: 10.1007/s00380-020-01587-z. Epub 2020 Apr 6.
This sub-analysis of the XAPASS, a prospective, single-arm, observational study, aimed to evaluate relationships between body mass index (BMI) and safety (major bleeding and all-cause mortality) and effectiveness [stroke/non-central nervous system (non-CNS) systemic embolism (SE)/myocardial infarction (MI)] outcomes in Japanese patients with non-valvular atrial fibrillation (NVAF) receiving rivaroxaban. Patients were categorized according to BMI (kg/m) as underweight (< 18.5), normal weight (18.5 to < 25), overweight (25 to < 30), or obese (≥ 30). In total, 9578 patients with NVAF completed the 1-year follow-up and were evaluated; of these, 7618 patients had baseline BMI data. Overall, 542 (5.7%), 4410 (46.0%), 2167 (22.6%), and 499 (5.2%) patients were underweight, normal weight, overweight, and obese, respectively. Multivariable Cox regression analysis demonstrated that none of the BMI categories were independent predictors of major bleeding whereas being underweight was independently associated with increased all-cause mortality [hazard ratio (HR) 3.56, 95% confidence interval (CI) 2.40-5.26, p < 0.001]. The incidence of stroke/non-CNS SE/MI was higher in patients who were underweight than in those of normal weight (HR 2.11, 95% CI 1.20-3.70, p = 0.009). However, in multivariable analyses, being underweight was not identified as an independent predictor of stroke/non-CNS SE/MI (HR 1.64, 95% CI 0.90-2.99, p = 0.104). In conclusion, the high incidence of thromboembolic events and all-cause mortality in patients who were underweight highlights that thorough evaluation of disease status and comorbidities may be required in this population.
本项对XAPASS（一项前瞻性单臂观察性研究）的亚组分析旨在评估接受利伐沙班治疗的日本非瓣膜性心房颤动（NVAF）患者的体重指数（BMI）与安全性（大出血和全因死亡率）以及有效性[中风/非中枢神经系统（非CNS）系统性栓塞（SE）/心肌梗死（MI）]结局之间的关系。患者根据BMI（kg/m²）分为体重过轻（<18.5）、正常体重（18.5至<25）、超重（25至<30）或肥胖（≥30）。共有9578例NVAF患者完成了1年随访并接受评估；其中，7618例患者有基线BMI数据。总体而言，体重过轻、正常体重、超重和肥胖的患者分别有542例（5.7%）、4410例（46.0%）、2167例（22.6%）和499例（5.2%）。多变量Cox回归分析表明，所有BMI类别均不是大出血的独立预测因素，而体重过轻与全因死亡率增加独立相关[风险比（HR）3.56，95%置信区间（CI）2.40 - 5.26，p<0.001]。体重过轻患者的中风/非CNS SE/MI发生率高于正常体重患者（HR 2.11，95%CI 1.20 - 3.70，p = 0.009）。然而，在多变量分析中，体重过轻未被确定为中风/非CNS SE/MI的独立预测因素（HR 1.64，95%CI 0.90 - 2.99，p = 0.104）。总之，体重过轻患者血栓栓塞事件和全因死亡率的高发生率突出表明，可能需要对该人群的疾病状态和合并症进行全面评估。
