Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK.
Ann Vasc Surg. 2022 Jan;78:288-294. doi: 10.1016/j.avsg.2021.06.022. Epub 2021 Aug 30.
The obesity paradox is a well-documented phenomenon in cardiovascular disease, however it remains poorly understood. We aimed to investigate the relationship between body mass (as measured by body mass index [BMI]) and 1-year amputation-free survival (AFS) for patients undergoing lower limb revascularisation for chronic limb-threatening ischaemia (CLTI).
A retrospective analysis was undertaken of all consecutive patients undergoing lower limb revascularisation for CLTI at the Leicester Vascular Institute between February 2018-19. Baseline demographics and outcomes were collected using electronic records. BMI was stratified using the World Health Organization criteria. One-year AFS (composite of major amputation/death) was the primary outcome. Kaplan-Meier survival analysis and adjusted Cox's proportional hazard models were used to compare groups to patients of normal mass.
One-hundred and ninety patients were included. Overall, no difference was identified in 1-year AFS across all groups (pooled P = 0.335). Compared to patients with normal BMI (n = 66), obese patients (n = 43) had a significantly lower adjusted combined risk of amputation/death (aHR 0.39, 95% CI 0.16-0.92, P = 0.032), however no significant differences were observed for overweight (aHR 0.89, 95% CI 0.47-1.70, P = 0.741), morbidly obese (aHR 1.15, 95% CI 0.41-3.20, P = 0.797) and underweight individuals (aHR 1.86, 95% CI 0.56-6.20, P = 0.314).
In the context of CLTI, obesity is potentially associated with favourable amputation-free survival at 1 year, compared to normal body mass. The results of this study support the notion of an obesity paradox existing within CLTI and question whether current guidance on weight management requires a more patient-specific approach.
肥胖悖论是心血管疾病中一个有充分文献记录的现象，但仍未被充分理解。我们旨在研究身体质量（通过身体质量指数[BMI]测量）与下肢血运重建的慢性肢体威胁性缺血（CLTI）患者 1 年无截肢生存率（AFS）之间的关系。
回顾性分析了 2018 年 2 月至 2019 年 2 月莱斯特血管研究所对 CLTI 进行下肢血运重建的所有连续患者。使用电子记录收集基线人口统计学和结局数据。BMI 使用世界卫生组织标准进行分层。1 年 AFS（主要截肢/死亡的复合结局）是主要结局。使用 Kaplan-Meier 生存分析和调整后的 Cox 比例风险模型将各组与正常体重患者进行比较。
共纳入 190 例患者。总体而言，所有组别的 1 年 AFS 无差异（汇总 P=0.335）。与 BMI 正常的患者（n=66）相比，肥胖患者（n=43）的截肢/死亡联合风险显著降低（调整后的危险比 [aHR] 0.39，95%置信区间 [CI] 0.16-0.92，P=0.032），但超重患者（aHR 0.89，95% CI 0.47-1.70，P=0.741）、病态肥胖患者（aHR 1.15，95% CI 0.41-3.20，P=0.797）和体重不足患者（aHR 1.86，95% CI 0.56-6.20，P=0.314）未见显著差异。
在 CLTI 背景下，与正常体重相比，肥胖患者 1 年时无截肢生存率可能更有利。本研究结果支持 CLTI 中存在肥胖悖论的观点，并质疑当前关于体重管理的指南是否需要更具患者特异性的方法。
