心力衰竭患者炎症和肥胖的健康结局。
The health outcomes of inflammation and obesity in patients with heart failure.
机构信息
School of Nursing, The University of Jordan, Queen Rania Street, Amman 11942, Jordan.
College of Nursing, University of Kentucky, 315 College of Nursing Building, 751 Rose Street, Lexington, KY 40536, United States.
出版信息
Heart Lung. 2020 Nov-Dec;49(6):896-901. doi: 10.1016/j.hrtlng.2020.05.010. Epub 2020 Jun 5.
BACKGROUND
Although obesity is a risk factor for cardiovascular disease, higher body mass index is related to longer event-free survival in patients with heart failure (HF). While previous research demonstrated that higher levels of inflammatory mediators were associated with shorter event-free survival, the effect of inflammation on the association between obesity and outcomes of HF have not been considered.
HYPOTHESIS
Based on the obesity paradox, we hypothesized that patients with higher baseline body mass index (BMI) would experience better event-free survival than those with lower BMI regardless of inflammatory status.
METHOD
A sample of 415 patients with HF (age 61 ± 11.5 years; 31% female) provided blood to measure soluble tumor necrosis factor receptor1 (sTNFR1), a biomarker of inflammation. Patients were divided into 4 groups based on BMI and a median split of sTNFR1 levels: (1) high BMI ≥ 30 and sTNFR1 > 1804 pg/ml, (2) high BMI ≥ 30 and low sTNFR1 ≤ 1804 pg/ml, and (3) low BMI < 30 and high sTNFR1 > 1804 pg/ml vs. (4) low BMI < 30 and sTNFR1 ≤ 1804 pg/ml. Patients were followed for an average of 365 days to determine the time to first event of either all-cause hospitalization or death.
RESULTS
There were 177 patients (43%) who experienced either an all-cause hospitalization or death. In a Cox regression, high BMI and high sTNFR1 category predicted time to event (hazard ratio = 1.7, 95% confidence interval = 1.01-2.9) with age, gender, race, left ventricular ejection fraction, New York Heart Association functional class (I/II versus III/IV), log-transformed N-terminal Pro-B-type natriuretic peptide levels, prescribed statin (yes/no), and comorbidity as covariates.
CONCLUSION
Being in a higher inflammation group was associated with shorter event-free survival regardless of BMI. This study provides evidence that inflammation is an important consideration in the association between obesity and better outcomes in patients with HF.
背景
尽管肥胖是心血管疾病的一个危险因素，但较高的体重指数与心力衰竭（HF）患者无事件生存时间延长有关。虽然之前的研究表明，较高水平的炎症介质与无事件生存时间较短有关，但炎症对肥胖与 HF 结局之间关联的影响尚未得到考虑。
假设
基于肥胖悖论，我们假设无论炎症状态如何，基线体重指数（BMI）较高的患者的无事件生存时间将优于 BMI 较低的患者。
方法
对 415 名 HF 患者（年龄 61 ± 11.5 岁，31%为女性）进行了抽样，检测了血液中的可溶性肿瘤坏死因子受体 1（sTNFR1），这是一种炎症生物标志物。患者根据 BMI 和 sTNFR1 水平的中位数分为 4 组：（1）高 BMI≥30 且 sTNFR1＞1804pg/ml，（2）高 BMI≥30 且 sTNFR1≤1804pg/ml，和（3）低 BMI＜30 且 sTNFR1＞1804pg/ml 与（4）低 BMI＜30 且 sTNFR1≤1804pg/ml。对患者进行了平均 365 天的随访，以确定首次发生全因住院或死亡的时间。
结果
共有 177 名患者（43%）发生了全因住院或死亡。在 Cox 回归中，高 BMI 和高 sTNFR1 类别预测了事件发生时间（风险比=1.7，95%置信区间=1.01-2.9），并将年龄、性别、种族、左心室射血分数、纽约心脏协会功能分级（I/II 与 III/IV）、对数转换的 N 末端 B 型利钠肽水平、处方他汀类药物（是/否）和合并症作为协变量。
结论
处于更高炎症组与无事件生存时间较短有关，无论 BMI 如何。这项研究提供了证据，表明炎症是肥胖与 HF 患者结局较好之间关联的一个重要考虑因素。
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