体脂肪百分比高可预测心力衰竭患者心脏事件风险较低：肥胖悖论的解释。
High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox.
机构信息
Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan.
出版信息
BMC Geriatr. 2021 Jan 6;21(1):16. doi: 10.1186/s12877-020-01950-9.
BACKGROUND
Although high body mass index (BMI) is a risk factor of heart failure (HF), HF patients with a higher BMI had a lower mortality rate than that in HF patients with normal or lower BMI, a phenomenon that has been termed the "obesity paradox". However, the relationship between body composition, i.e., fat or muscle mass, and clinical outcome in HF remains unclear.
METHODS
We retrospectively analyzed data for 198 consecutive HF patients (76 years of age; males, 49%). Patients who were admitted to our institute for diagnosis and management of HF and received a dual-energy X-ray absorptiometry scan were included regardless of left ventricular ejection fraction (LVEF) categories. Muscle wasting was defined as appendicular skeletal muscle mass index < 7.0 kg/m in males and < 5.4 kg/m in females. Increased percent body fat mass (increased FM) was defined as percent body fat > 25% in males and > 30% in females.
RESULTS
The median age of the patients was 76 years (interquartile range [IQR], 67-82 years) and 49% of them were male. The median LVEF was 47% (IQR, 33-63%) and 33% of the patients had heart failure with reduced ejection fraction. Increased FM and muscle wasting were observed in 58 and 67% of the enrolled patients, respectively. During a 180-day follow-up period, 32 patients (16%) had cardiac events defined as cardiac death or readmission by worsening HF or arrhythmia. Kaplan-Meier survival curves showed that patients with increased FM had a lower cardiac event rate than did patients without increased FM (11.4% vs. 22.6%, p = 0.03). Kaplan-Meier curves of cardiac event rates did not differ between patients with and those without muscle wasting (16.5% vs. 15.4%, p = 0.93). In multivariate Cox regression analyses, increased FM was independently associated with lower cardiac event rates (hazard ratio: 0.45, 95% confidence interval: 0.22-0.93) after adjustment for age, sex, diabetes, muscle wasting, and renal function.
CONCLUSIONS
High percent body fat mass is associated with lower risk of short-term cardiac events in HF patients.
背景
尽管高体重指数（BMI）是心力衰竭（HF）的一个危险因素，但 BMI 较高的 HF 患者的死亡率低于 BMI 正常或较低的 HF 患者，这种现象被称为“肥胖悖论”。然而，身体成分（即脂肪或肌肉质量）与 HF 患者临床结局之间的关系尚不清楚。
方法
我们回顾性分析了 198 例连续 HF 患者（76 岁；男性 49%）的数据。本研究纳入了因 HF 诊断和管理而入住我院并接受双能 X 线吸收法扫描的患者，无论左心室射血分数（LVEF）类别如何。肌肉减少症定义为四肢骨骼肌质量指数<7.0kg/m2 男性和<5.4kg/m2 女性。体脂百分比增加（增加 FM）定义为男性体脂百分比>25%，女性体脂百分比>30%。
结果
患者的中位年龄为 76 岁（四分位距[IQR]，67-82 岁），49%为男性。中位 LVEF 为 47%（IQR，33-63%），33%的患者为射血分数降低的心力衰竭。纳入的患者中分别有 58%和 67%的患者出现 FM 增加和肌肉减少症。在 180 天的随访期间，32 名患者（16%）发生了心脏事件，定义为心脏死亡或因 HF 恶化或心律失常再入院。Kaplan-Meier 生存曲线显示，FM 增加的患者心脏事件发生率低于 FM 未增加的患者（11.4%比 22.6%，p=0.03）。Kaplan-Meier 曲线显示，有肌肉减少症和无肌肉减少症的患者心脏事件发生率无差异（16.5%比 15.4%，p=0.93）。多变量 Cox 回归分析显示，在校正年龄、性别、糖尿病、肌肉减少症和肾功能后，FM 增加与短期心脏事件发生率降低独立相关（风险比：0.45，95%置信区间：0.22-0.93）。
结论
HF 患者体脂百分比高与短期心脏事件风险降低相关。
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