Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Cardiology Department, Middlemore Hospital, Auckland, New Zealand; School of Population Health and Department of Medicine, University of Auckland, Auckland, New Zealand.
Heart Lung Circ. 2021 Dec;30(12):1854-1862. doi: 10.1016/j.hlc.2021.04.014. Epub 2021 May 31.
Some studies have suggested a lower mortality in obese subjects with cardiovascular disease. The aim of this study was to evaluate the relationship between body mass index (BMI) and outcomes in patients with acute coronary syndrome (ACS).
The study included 13,742 patients undergoing coronary angiography for ACS between 2012 and 2016 from the All New Zealand Acute Coronary Syndrome-Quality Improvement (ANZACS-QI) registry. Patients were categorised by BMI (kg/m) as: underweight <18.5, normal 18.5 to <25, overweight 25 to <30, mildly obese 30 to <35, moderately obese 35 to <40, and severely obese ≥40. The primary endpoint of the study was all cause mortality with secondary endpoints of cardiovascular disease (CVD) and non-CVD mortality within 4 years of discharge.
Unadjusted all cause mortality was lowest in the mildly obese but no different to normal or overweight after adjustment for multiple confounders. Adjusted all cause mortality was higher in the moderately (hazard ratio [HR] 1.39, 95% CI: 1.10-1.75) and severely obese (2.06, 95% CI: 1.57-2.70) compared to the mildly obese. Non-CVD mortality (HR 1.58, 95% CI: 1.12-2.23) was the major contributor to higher all cause mortality in moderately obese patients. Both CVD mortality (HR 2.36, 95% CI: 1.67-3.32) and non-CVD mortality (HR 1.67, 95% CI: 1.07-2.61) contributed to higher all cause mortality in the severely obese.
Moderate and severe obesity is associated with worse survival post ACS influenced by higher non-CVD mortality in moderate/severe obesity and higher CVD mortality in severe obesity.
一些研究表明心血管疾病患者中肥胖人群的死亡率较低。本研究旨在评估体质量指数（BMI）与急性冠状动脉综合征（ACS）患者结局的关系。
该研究纳入了 2012 年至 2016 年期间来自新西兰所有急性冠状动脉综合征质量改进（ANZACS-QI）注册研究的 13742 例行冠状动脉造影检查的 ACS 患者。患者根据 BMI（kg/m2）分为：体重不足<18.5，正常 18.5-<25，超重 25-<30，轻度肥胖 30-<35，中度肥胖 35-<40，和重度肥胖≥40。本研究的主要终点是所有原因死亡率，次要终点是出院后 4 年内心血管疾病（CVD）和非 CVD 死亡率。
未校正的所有原因死亡率在轻度肥胖患者中最低，但在调整了多种混杂因素后，与正常或超重患者无差异。与轻度肥胖患者相比，中度（风险比[HR]1.39，95%CI：1.10-1.75）和重度肥胖（2.06，95%CI：1.57-2.70）患者的校正后所有原因死亡率更高。非 CVD 死亡率（HR 1.58，95%CI：1.12-2.23）是中度肥胖患者全因死亡率升高的主要原因。CVD 死亡率（HR 2.36，95%CI：1.67-3.32）和非 CVD 死亡率（HR 1.67，95%CI：1.07-2.61）均导致重度肥胖患者全因死亡率升高。
中度和重度肥胖与 ACS 后生存率较差相关，这与中度/重度肥胖患者非 CVD 死亡率较高以及重度肥胖患者 CVD 死亡率较高有关。
