代谢表型与稳定型胸痛患者的冠心病和心血管事件的相关性。
Association of Metabolic Phenotypes With Coronary Artery Disease and Cardiovascular Events in Patients With Stable Chest Pain.
机构信息
Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Division of Cardiology, Medical University of Vienna, Vienna, Austria.
出版信息
Diabetes Care. 2021 Apr;44(4):1038-1045. doi: 10.2337/dc20-1760. Epub 2021 Feb 8.
OBJECTIVE
Obesity and metabolic syndrome are associated with major adverse cardiovascular events (MACE). However, whether distinct metabolic phenotypes differ in risk for coronary artery disease (CAD) and MACE is unknown. We sought to determine the association of distinct metabolic phenotypes with CAD and MACE.
RESEARCH DESIGN AND METHODS
We included patients from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) who underwent coronary computed tomography (CT) angiography. Obesity was defined as a BMI ≥30 kg/m and metabolically healthy as less than or equal to one metabolic syndrome component except diabetes, distinguishing four metabolic phenotypes: metabolically healthy/unhealthy and nonobese/obese (MHN, MHO, MUN, and MUO). Differences in severe calcification (coronary artery calcification [CAC] ≥400), severe CAD (≥70% stenosis), high-risk plaque (HRP), and MACE were assessed using adjusted logistic and Cox regression models.
RESULTS
Of 4,381 patients (48.4% male, 60.5 ± 8.1 years of age), 49.4% were metabolically healthy (30.7% MHN and 18.7% MHO) and 50.6% unhealthy (22.3% MUN and 28.4% MUO). MHO had similar coronary CT findings as compared with MHN (severe CAC/CAD and HRP; > 0.36 for all). Among metabolically unhealthy patients, those with obesity had similar CT findings as compared with nonobese ( > 0.10 for all). However, both MUN and MUO had unfavorable CAD characteristics as compared with MHN ( ≤ 0.017 for all). A total of 130 events occurred during follow-up (median 26 months). Compared with MHN, MUN (hazard ratio [HR] 1.61 [95% CI 1.02-2.53]) but not MHO (HR 1.06 [0.62-1.82]) or MUO (HR 1.06 [0.66-1.72]) had higher risk for MACE.
CONCLUSIONS
In patients with stable chest pain, four metabolic phenotypes exhibit distinctly different CAD characteristics and risk for MACE. Individuals who are metabolically unhealthy despite not being obese were at highest risk in our cohort.
目的
肥胖和代谢综合征与主要不良心血管事件（MACE）有关。然而，不同的代谢表型在冠心病（CAD）和 MACE 风险方面是否存在差异尚不清楚。我们旨在确定不同的代谢表型与 CAD 和 MACE 的关系。
研究设计和方法
我们纳入了接受冠状动脉计算机断层扫描（CT）血管造影检查的前瞻性多中心影像学研究评估胸痛（PROMISE）患者。肥胖定义为 BMI≥30kg/m2，代谢健康定义为除糖尿病以外的代谢综合征成分≤1 个，区分四种代谢表型：代谢健康/不健康和非肥胖/肥胖（MHN、MHO、MUN 和 MUO）。使用调整后的逻辑和 Cox 回归模型评估严重钙化（冠状动脉钙化[CAC]≥400）、严重 CAD（≥70%狭窄）、高危斑块（HRP）和 MACE 的差异。
结果
在 4381 名患者中（48.4%为男性，60.5±8.1 岁），49.4%为代谢健康（30.7%为 MHN，18.7%为 MHO），50.6%为代谢不健康（22.3%为 MUN，28.4%为 MUO）。与 MHN 相比，MHO 的冠状动脉 CT 表现相似（严重 CAC/CAD 和 HRP；所有比较均>0.36）。在代谢不健康的患者中，与非肥胖患者相比，肥胖患者的 CT 表现相似（所有比较均>0.10）。然而，与 MHN 相比，MUN 和 MUO 的 CAD 特征均不理想（所有比较均≤0.017）。随访期间共发生 130 例事件（中位时间 26 个月）。与 MHN 相比，MUN（危险比[HR]1.61[95%CI 1.02-2.53]）而非 MHO（HR 1.06[0.62-1.82]）或 MUO（HR 1.06[0.66-1.72]）发生 MACE 的风险更高。
结论
在稳定胸痛患者中，四种代谢表型表现出明显不同的 CAD 特征和 MACE 风险。在我们的队列中，尽管不肥胖但代谢不健康的个体风险最高。
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