Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, HsinChu, Taiwan, ROC.
Int J Obes (Lond). 2022 Aug;46(8):1425-1434. doi: 10.1038/s41366-022-01143-x. Epub 2022 May 16.
The "obesity paradox" - in which patients with obesity exhibit superior survival than normal-weight counterparts - has been reported for several diseases. However, obesity is a well-known risk factor for cardiovascular disease, and whether the obesity paradox is present in peripheral artery disease (PAD) is unknown.
A comprehensive search for studies that reported mortality in patients with PAD grouped by BMI identified 12 studies. We compared the survival of underweight patients with those who were not underweight, and patients with obesity against those without. Underweight was defined by a BMI value of <18.5 kg/m in most studies and obesity by BMI ≥ 30 kg/m. Subgroup analyses were performed according to length of follow-up, presentation of PAD, and mode of revascularization. Meta-regression analyses were conducted, with covariates including age, sex, presence of coronary artery disease (CAD) and diabetes mellitus (DM).
The mortality risk of underweight patients with PAD was significantly higher compared to those who are not underweight (HR 1.72, 95% CI 1.38-2.14; I = 84.2%). In contrast, the mortality risk of patients with obesity with PAD was significantly lower than those without (HR 0.78, 95% CI 0.62-0.97; I = 89.8%). These findings remained consistent regardless of the presentation of PAD, revascularization, age, sex, or presence of CAD. The risk of death in the short-term of underweight patients (HR 1.50, 95% CI 0.47-4.72) and patients with obesity (HR 0.86, 95% CI 0.66-1.13) were not significantly different from their counterparts. The meta-regression showed that of the association between obesity and better survival was more pronounced in studies with a greater proportion of patients with concomitant CAD (regression coefficient -0.029, 95% CI -0.054 to -0.004).
In patients with PAD, mortality is higher among underweight patients and lower among patients with obesity. The mechanisms underlying the obesity paradox in patients with PAD remain to be elucidated, and further evidence is required to guide optimal weight control strategies in these patients.
肥胖悖论是指肥胖患者的生存优于体重正常的患者，这种现象在多种疾病中均有报道。然而，肥胖是心血管疾病的一个众所周知的危险因素，肥胖悖论是否存在于外周动脉疾病（PAD）中尚不清楚。
通过全面检索按 BMI 分组报告 PAD 患者死亡率的研究，确定了 12 项研究。我们比较了体重不足患者与非体重不足患者以及肥胖患者与非肥胖患者的生存率。大多数研究中，体重不足定义为 BMI 值<18.5kg/m，肥胖定义为 BMI≥30kg/m。根据随访时间、PAD 表现和血运重建方式进行亚组分析。进行了荟萃回归分析，协变量包括年龄、性别、是否存在冠状动脉疾病（CAD）和糖尿病（DM）。
与非体重不足的患者相比，体重不足的 PAD 患者的死亡风险明显更高（HR 1.72，95%CI 1.38-2.14；I=84.2%）。相比之下，患有 PAD 的肥胖患者的死亡风险明显低于无肥胖的患者（HR 0.78，95%CI 0.62-0.97；I=89.8%）。无论 PAD 的表现、血运重建、年龄、性别或 CAD 的存在如何，这些发现均保持一致。体重不足患者（HR 1.50，95%CI 0.47-4.72）和肥胖患者（HR 0.86，95%CI 0.66-1.13）在短期的死亡风险方面与对照组无显著差异。荟萃回归显示，在伴有更多 CAD 患者的研究中，肥胖与更好的生存之间的关联更为显著（回归系数-0.029，95%CI-0.054 至-0.004）。
在 PAD 患者中，体重不足患者的死亡率较高，而肥胖患者的死亡率较低。PAD 患者中肥胖悖论的机制尚不清楚，需要进一步的证据来指导这些患者的最佳体重控制策略。
