Liu Lei, Liu Xiaoyan, Ding Xiaosong, Chen Hui, Li Hongwei
Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, People's Republic of China.
Int J Gen Med. 2022 Jun 21;15:5717-5728. doi: 10.2147/IJGM.S367868. eCollection 2022.
The "obesity paradox" has not been elucidated in the long-term outcomes in acute myocardial infarction (AMI) patients. This study sought to characterize the relationship between body mass index (BMI) and the risk of new-onset atrial fibrillation (NOAF).
A total of 4282 participants free from AF at baseline were identified at Beijing Friendship Hospital. Baseline body mass index (BMI) was categorized into four groups. Incidence of NOAF was observed at the follow-up visits. The associations between different BMI categories and the incidence of NOAF were assessed by multivariate Cox regression analysis.
Over a median follow-up period of 42.0 months, 4282 participants (age 62.7 ± 6.6 years, 38.7% women) were enrolled, 23.0% were BMI <23.0kg/m, 22.5% were 23.0-24.9 kg/m, 44.3% were 25.0-29.9 kg/m and 10.2% were ≥30.0 kg/m. Compared with patients with the lowest BMI levels, those with BMI≥30 kg/m showed a younger, higher inflammatory response and a larger left atrium and were more likely to be combined with traditional cardiovascular risk factors. After adjustment for confounding variables, compared to BMI ≥30 kg/m group, patients with lower BMI (<23 kg/m) significantly increased the risk of NOAF in AMI patients (HR 2.884, 95% CI 1.302-6.392). Moreover, the all-cause mortality and cardiac mortality in BMI <23.0kg/m group was apparently higher than that in BMI≥30 kg/m group after a long-term follow-up.
In this AMI cohort study, the present finding of an inverse association between BMI and risk of NOAF supports the "obesity paradox". Decreasing BMI was associated with an increased risk of NOAF.
Prospective registered.
“肥胖悖论”在急性心肌梗死（AMI）患者的长期预后中尚未得到阐明。本研究旨在描述体重指数（BMI）与新发房颤（NOAF）风险之间的关系。
在北京友谊医院共确定了4282名基线时无房颤的参与者。基线体重指数（BMI）分为四组。在随访中观察NOAF的发生率。通过多变量Cox回归分析评估不同BMI类别与NOAF发生率之间的关联。
在中位随访期42.0个月内，纳入了4282名参与者（年龄62.7±6.6岁，38.7%为女性），23.0%的BMI<23.0kg/m，22.5%的BMI为23.0 - 24.9kg/m，44.3%的BMI为25.0 - 29.9kg/m，10.2%的BMI≥30.0kg/m。与BMI最低水平的患者相比，BMI≥30kg/m的患者更年轻，炎症反应更高，左心房更大，并且更有可能合并传统心血管危险因素。在调整混杂变量后，与BMI≥30kg/m组相比，BMI较低（<23kg/m）的患者在AMI患者中发生NOAF的风险显著增加（HR 2.884，95%CI 1.302 - 6.392）。此外，经过长期随访，BMI<23.0kg/m组的全因死亡率和心脏死亡率明显高于BMI≥30kg/m组。
在这项AMI队列研究中，目前发现BMI与NOAF风险之间存在负相关，支持了“肥胖悖论”。BMI降低与NOAF风险增加相关。
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