Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA 90048, USA.
Women's Heart Center, The Christ Hospital Heart and Vascular Institute, 2139 Auburn Ave, Cincinnati, OH 45219, USA.
Eur J Prev Cardiol. 2022 Sep 7;29(12):1608-1614. doi: 10.1093/eurjpc/zwac046.
Body mass index (BMI) defined obesity is paradoxically associated with lower all-cause mortality in patients with known cardiovascular disease. This study aims to determine the role of physical fitness in the obesity paradox in women with ischaemic heart disease (IHD).
Women undergoing invasive coronary angiography with signs/symptoms of IHD in the Women's Ischemia Syndrome Evaluation (WISE) prospective cohort (enrolled 1997-2001) were analysed. This study investigated the longer-term risk of major adverse cardiovascular events (MACE) and all-cause mortality associated with BMI and physical fitness measured by Duke Activity Status Index (DASI). Overweight was defined as BMl ≥25 to 30 kg/m2, obese as BMI ≥30 kg/m2, unfit as DASI scores <25, equivalent to ≤7 metabolic equivalents. Among 899 women, 18.6% were normal BMI-fit, 11.4% overweight-fit, 10.4% obese-fit, 15.3% normal BMI-unfit, 23.8% overweight-unfit, and 30.4% obese-unfit. In adjusted models compared to normal BMI-fit, normal BMI-unfit women had higher MACE risk [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.17-2.32; P = 0.004]; whereas obese-fit and overweight-fit women had lower risk of mortality (HR 0.60, 95% CI 0.40-0.89; P = 0.012 and HR 0.62, 95% CI 0.41-0.92; P = 0.018, respectively).
To address the paradox of body weight and outcomes in women, we report for the first time that among women with signs/symptoms of IHD overweight-fit and obese-fit were at lower risk of long-term all-cause mortality; whereas normal BMI-unfit were at higher risk of MACE. Physical fitness may contribute to the obesity paradox in women, warranting future studies to better understand associations between body weight, body composition, and physical fitness to improve cardiovascular outcomes in women.
体重指数（BMI）定义的肥胖与已知心血管疾病患者的全因死亡率呈负相关。本研究旨在确定身体适应性在缺血性心脏病（IHD）女性肥胖悖论中的作用。
对 Women's Ischemia Syndrome Evaluation（WISE）前瞻性队列研究中出现 IHD 症状/体征并接受介入性冠状动脉造影的女性（1997-2001 年招募）进行分析。本研究调查了 BMI 和 Duke 活动状态指数（DASI）测量的身体适应性与 BMI 和身体适应性相关的主要不良心血管事件（MACE）和全因死亡率的长期风险。超重定义为 BMI≥25 至 30kg/m2，肥胖定义为 BMI≥30kg/m2，不适应定义为 DASI 评分 <25，相当于 ≤7 代谢当量。在 899 名女性中，18.6%为正常 BMI 适应型，11.4%为超重适应型，10.4%为肥胖适应型，15.3%为正常 BMI 不适应型，23.8%为超重不适应型，30.4%为肥胖不适应型。在调整后的模型中，与正常 BMI 适应型相比，正常 BMI 不适应型女性的 MACE 风险更高[风险比（HR）1.65，95%置信区间（CI）1.17-2.32；P=0.004]；而肥胖适应型和超重适应型女性的死亡率风险较低（HR 0.60，95%CI 0.40-0.89；P=0.012 和 HR 0.62，95%CI 0.41-0.92；P=0.018）。
为了解决体重与女性结局之间的悖论，我们首次报告称，在有 IHD 症状/体征的女性中，超重适应型和肥胖适应型的长期全因死亡率风险较低；而正常 BMI 不适应型的 MACE 风险较高。身体适应性可能是女性肥胖悖论的原因之一，这需要进一步的研究来更好地理解体重、身体成分和身体适应性之间的关系，以改善女性的心血管结局。
