Endocrinology and Cardiovascular Disease Centre, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China; State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
Nutr Metab Cardiovasc Dis. 2021 Feb 8;31(2):448-454. doi: 10.1016/j.numecd.2020.09.011. Epub 2020 Sep 17.
It is still controversial whether obesity and overweight increase the risk of mortality for patients with coronary artery disease. The current study aimed to investigate the relationship between body mass index (BMI) and mortality in patients with triple-vessel disease (TVD).
From April 2004 to February 2011, 8943 patients with angiographically confirmed TVD were consecutively enrolled. Patients were divided into five groups according to BMI: underweight (<18.5 kg/m), normal weight (18.5-23.9 kg/m), overweight: (24-27.9 kg/m), mild obesity (28-31.9 kg/m), and severe obesity (≥32 kg/m). The primary end point was all-cause death. Subgroup analysis was performed for treatment strategies: revascularization and medical treatment alone. During a median follow-up of 7.5 years, lower risks of mortality were observed in patients with overweight (adjusted HR 0.85, 95% CI 0.75-0.97) and mild obesity (adjusted HR 0.83, 95% CI 0.69-1.00) compared to those with normal weight. Polynomial Cox regression suggested a U-shape association between BMI and adjusted mortality risk. In the revascularization subgroup, there was a significantly higher mortality risk in patients with severe obesity (adjusted HR 1.57, 95% CI 1.03-2.40) than in those with normal weight. While in the medical treatment subgroup, mortality risk decreased as BMI increased, with the lowest risk being observed in patients with severe obesity.
There is a U-shape relationship between BMI and all-cause death in patients with TVD, with increased risks among both underweight and severely obese patients. This relationship may be influenced by treatment strategies.
肥胖和超重是否会增加冠心病患者的死亡风险仍存在争议。本研究旨在探讨体重指数（BMI）与三血管病变（TVD）患者死亡率之间的关系。
本研究纳入了 2004 年 4 月至 2011 年 2 月期间经血管造影证实患有 TVD 的 8943 例患者。根据 BMI 将患者分为五组：体重过低（<18.5kg/m²）、正常体重（18.5-23.9kg/m²）、超重（24-27.9kg/m²）、轻度肥胖（28-31.9kg/m²）和重度肥胖（≥32kg/m²）。主要终点为全因死亡。进行了治疗策略的亚组分析：单独血运重建和单纯药物治疗。在中位随访 7.5 年期间，与正常体重患者相比，超重（校正 HR 0.85，95%CI 0.75-0.97）和轻度肥胖（校正 HR 0.83，95%CI 0.69-1.00）患者的死亡风险较低。多项式 Cox 回归提示 BMI 与校正死亡率风险之间呈 U 形关联。在血运重建亚组中，与正常体重患者相比，重度肥胖患者的死亡率风险显著升高（校正 HR 1.57，95%CI 1.03-2.40）。而在药物治疗亚组中，随着 BMI 的增加，死亡率风险降低，重度肥胖患者的风险最低。
在患有 TVD 的患者中，BMI 与全因死亡之间呈 U 形关系，体重过低和重度肥胖患者的风险增加。这种关系可能受到治疗策略的影响。
