Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Aging (Albany NY). 2020 Jun 16;12(12):12175-12186. doi: 10.18632/aging.103394.
A single index of body mass index (BMI) may not fully address its impact on anti-platelet therapy. We aimed to elucidate the combined impact of BMI and dysglycemia expressed by glycated albumin (GA) on efficacy of clopidogrel-aspirin therapy among minor stroke (MS) or transient ischemic attack (TIA) patients.
Patients with overweight/obesity and low GA levels still benefited from clopidogrel-aspirin therapy for stroke recurrence (Hazard ratio [HR]: 0.48, 95 % confidence interval [CI]: 0.28-0.82), so did those with high GA levels but low/normal weight (HR: 0.67, 95 % CI: 0.45-0.99). However, patients with both overweight/obesity and high GA levels did not benefit from clopidogrel-aspirin therapy (HR: 0.89, 95 % CI: 0.59-1.33).
Compared with aspirin alone, efficacy of clopidogrel-aspirin therapy for stroke still exists in overweight/obesity patients with normal glycemic control.
In Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial, 3044 patients with available baseline GA were recruited. Low/normal weight and overweight/obesity were defined as BMI < 25 kg/m and ≥ 25 kg/m, respectively. Elevated and low GA levels were defined as GA levels > 15.5 % and ≤ 15.5 %, respectively. The primary outcome was stroke recurrence during the 90-day follow-up.
单一的体重指数（BMI）指数可能无法充分反映其对抗血小板治疗的影响。我们旨在阐明糖化白蛋白（GA）所表示的血糖异常与 BMI 联合对小卒中（MS）或短暂性脑缺血发作（TIA）患者氯吡格雷-阿司匹林治疗效果的影响。
超重/肥胖且 GA 水平较低的患者仍从氯吡格雷-阿司匹林治疗中获益，卒中复发风险降低（风险比[HR]：0.48，95%置信区间[CI]：0.28-0.82），GA 水平较高但体重低/正常的患者也是如此（HR：0.67，95%CI：0.45-0.99）。然而，超重/肥胖且 GA 水平较高的患者并未从氯吡格雷-阿司匹林治疗中获益（HR：0.89，95%CI：0.59-1.33）。
与单独使用阿司匹林相比，氯吡格雷-阿司匹林治疗在血糖控制正常的超重/肥胖患者中仍能有效预防卒中。
在急性非致残性脑血管事件高危患者中应用氯吡格雷试验中，纳入了 3044 例基线时可获得 GA 的患者。低/正常体重和超重/肥胖定义为 BMI<25kg/m 和≥25kg/m，分别。GA 水平升高和降低定义为 GA 水平>15.5%和≤15.5%。主要结局是 90 天随访期间的卒中复发。
