Department of Medicine, University of Pittsburgh Medical Center, Pittsburg, Pennsylvania, USA.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburg, Pennsylvania, USA.
Clin Cardiol. 2021 Apr;44(4):495-500. doi: 10.1002/clc.23556. Epub 2021 Mar 6.
Obesity is a worldwide epidemic that has been associated with poor outcomes. Previous studies have demonstrated an inverse relationship between body mass index (BMI) and outcomes, the 'obesity paradox', in several diseases.
We sought to evaluate whether the obesity paradox is present in patients with left ventricular systolic dysfunction (LVSD) of all etiologies, using all-cause mortality as the primary endpoint and hospitalization as the secondary endpoint.
We conducted a retrospective cohort study of LVSD patients (n = 18 003) seen within the University of Pittsburgh Medical Center network between January 2011 and December 2017. Patients were divided into four BMI categories (underweight, normal weight, overweight, and obese) and stratified by left ventricular ejection fraction (LVEF): <20%, 20-35%, and 35-50%.
Over a median follow-up of 2.28 years, higher BMI (mean 28.9 ± 6.8) was associated with better survival for the overall cohort and within LVEF strata (p < .0001). The most common cause of hospitalization was subendocardial infarction among underweight and normal weight patients and heart failure among overweight and obese patients. Cox proportional hazards model showed that BMI, age, and comorbid conditions of diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and prior myocardial infarction are independent predictors of death.
Our results support the existence of an obesity paradox impacting all-cause mortality in patients with LVSD of ischemic and non-ischemic etiologies even after adjusting for LVEF and comorbidities. Additional research is needed to understand the effect of weight loss on survival once a diagnosis of LVSD is established.
肥胖是一种全球性的流行疾病，与不良结局相关。先前的研究表明，在几种疾病中，体重指数（BMI）与结局之间存在反比关系，即“肥胖悖论”。
我们旨在评估“肥胖悖论”是否存在于所有病因的左心室收缩功能障碍（LVSD）患者中，以全因死亡率为主要终点，以住院为次要终点。
我们对 2011 年 1 月至 2017 年 12 月期间在匹兹堡大学医学中心网络内就诊的 LVSD 患者（n = 18003）进行了回顾性队列研究。患者分为四个 BMI 类别（体重不足、正常体重、超重和肥胖），并按左心室射血分数（LVEF）分层：<20%、20-35%和 35-50%。
在中位数为 2.28 年的随访期间，较高的 BMI（平均 28.9 ± 6.8）与整个队列以及 LVEF 分层内的生存改善相关（p<0.0001）。体重不足和正常体重患者最常见的住院原因是心内膜下心肌梗死，超重和肥胖患者最常见的住院原因是心力衰竭。Cox 比例风险模型显示，BMI、年龄以及糖尿病、慢性阻塞性肺疾病、慢性肾脏病和既往心肌梗死等合并症是死亡的独立预测因素。
我们的结果支持“肥胖悖论”的存在，即使在调整 LVEF 和合并症后，它也会影响缺血性和非缺血性病因的 LVSD 患者的全因死亡率。需要进一步研究以了解一旦确诊 LVSD，体重减轻对生存的影响。
