代谢健康/不健康的超重/肥胖与绝经后女性心力衰竭事件的关系：妇女健康倡议。
Metabolically Healthy/Unhealthy Overweight/Obesity Associations With Incident Heart Failure in Postmenopausal Women: The Women's Health Initiative.
机构信息
Heart Disease Prevention Program, Division of Cardiology, Department of Medicine (A.R.C.H., N.D.W.), UC Irvine School of Medicine, University of California.
School of Community and Global Health, Claremont Graduate University, The Claremont Colleges, CA (A.R.C.H., B.X., D.V.P.).
出版信息
Circ Heart Fail. 2021 Apr;14(4):e007297. doi: 10.1161/CIRCHEARTFAILURE.120.007297. Epub 2021 Mar 29.
BACKGROUND
Obesity is associated with an increased risk of heart failure (HF); however, how metabolic weight groups relate to HF risk, especially in postmenopausal women, has not been demonstrated.
METHODS
We included 19 412 postmenopausal women ages 50 to 79 without cardiovascular disease from the Women's Health Initiative. Normal weight was defined as a body mass index ≥18.5 and <25 kg/m and waist circumference <88 cm and overweight/obesity as a body mass index ≥25 kg/m or waist circumference ≥88 cm. Metabolically healthy was based on <2 and unhealthy ≥2 cardiometabolic traits: triglycerides ≥150 mg/dL, systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg or blood pressure medication, fasting glucose ≥100 mg/dL or diabetes medication, and HDL-C (high-density lipoprotein cholesterol) <50 mg/dL. Risk factor-adjusted Cox regression examined the hazard ratios (HRs) for incident hospitalized HF among metabolically healthy normal weight (reference), metabolically unhealthy normal weight, metabolically healthy overweight/obese, and metabolically unhealthy overweight/obese.
RESULTS
Among our sample, 455 (2.34%) participants experienced HF hospitalizations over a mean follow-up time of 11.3±1.1 years. Compared with metabolically healthy normal weight individuals, HF risk was greater in metabolically unhealthy normal weight (HR, 1.66 [95% CI, 1.01-2.72], =0.045) and metabolically unhealthy overweight/obese individuals (HR, 1.95 [95% CI, 1.35-2.80], =0.0004), but not metabolically healthy overweight/obese individuals (HR, 1.15 [95% CI, 0.78-1.71], =0.48). Subdividing the overweight/obese into separate groups showed HRs for metabolically unhealthy obese of 2.62 (95% CI, 1.80-3.83; <0.0001) and metabolically healthy obese of 1.52 (95% CI, 0.98-2.35; =0.06).
CONCLUSIONS
Metabolically unhealthy overweight/obese and metabolically unhealthy normal weight are associated with an increased risk of HF in postmenopausal women.
背景
肥胖与心力衰竭（HF）风险增加相关；然而，代谢体重组与 HF 风险的关系如何，特别是在绝经后妇女中，尚未得到证实。
方法
我们纳入了来自妇女健康倡议的 19412 名年龄在 50 至 79 岁之间、无心血管疾病的绝经后妇女。正常体重定义为身体质量指数（BMI）≥18.5 且<25kg/m2 且腰围<88cm，超重/肥胖定义为 BMI≥25kg/m2 或腰围≥88cm。代谢健康基于<2 个和不健康≥2 个心血管代谢特征：甘油三酯≥150mg/dL、收缩压≥130mmHg 或舒张压≥85mmHg 或使用降压药物、空腹血糖≥100mg/dL 或使用降糖药物、高密度脂蛋白胆固醇（HDL-C）<50mg/dL。采用风险因素调整的 Cox 回归分析了代谢健康正常体重（参考）、代谢不健康正常体重、代谢健康超重/肥胖和代谢不健康超重/肥胖者中发生住院 HF 的风险比（HR）。
结果
在我们的样本中，455（2.34%）名参与者在平均 11.3±1.1 年的随访期间经历了 HF 住院治疗。与代谢健康的正常体重者相比，代谢不健康的正常体重者（HR，1.66[95%CI，1.01-2.72]，=0.045）和代谢不健康的超重/肥胖者（HR，1.95[95%CI，1.35-2.80]，=0.0004）HF 风险更高，但代谢健康的超重/肥胖者（HR，1.15[95%CI，0.78-1.71]，=0.48）并非如此。将超重/肥胖进一步分为单独的组后发现，代谢不健康肥胖者的 HR 为 2.62（95%CI，1.80-3.83；<0.0001），代谢健康肥胖者的 HR 为 1.52（95%CI，0.98-2.35；=0.06）。
结论
代谢不健康的超重/肥胖和代谢不健康的正常体重与绝经后妇女 HF 风险增加相关。
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