Nezu Mari, Ueda Shinichiro, Uchida Kazutaka, Sakakibara Fumihiro, Kinjo Norito, Arai Hideki, Morimoto Takeshi
Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus, Nishihara, Japan.
Heart Vessels. 2023 Apr;38(4):551-561. doi: 10.1007/s00380-022-02194-w. Epub 2022 Nov 4.
The association between body mass index (BMI) and clinical outcomes of patients with non-valvular atrial fibrillation (NVAF) taking oral anticoagulants (OACs) are controversial, and we thus analyzed the large registry data to elucidate them.
We conducted a historical cohort study at 71 centers in Japan and included outpatients with NVAF taking vitamin K antagonists (VKAs). Physicians in charge could change VKAs to direct OACs based on their judgement during follow-up period. We categorized patients into four BMI groups (kg/m): underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (30 ≤ BMI). The effects of each BMI group relative to the normal weight group on clinical outcomes consisting of all-cause death, ischemic events, and bleeding events were estimated using Cox proportional hazard models adjusting for potential confounders. We also constructed restricted cubic spline regression model adjusted by multivariable Cox proportional hazard models. We included 6927 patients consisting of an underweight (n = 386), normal weight (n = 3785), overweight (n = 2174), and obese (n = 582) groups. The median follow-up period was 3.9 years. In the underweight group, the adjusted hazard ratios (HRs) for all-cause death and ischemic events were 1.75 (1.30-2.34) and 1.61 (1.04-2.50). The HR for all-cause death was 0.63 (0.49-0.82) in the overweight group. Restricted cubic spline regression models confirmed that lower BMI showed significantly higher risks for all-cause death and ischemic events.
Among NVAF patients taking OACs, underweight patients had higher risks of all-cause death and ischemic events than other patients. Overweight patients had lower risk of all-cause death.
体重指数（BMI）与服用口服抗凝剂（OAC）的非瓣膜性心房颤动（NVAF）患者临床结局之间的关联存在争议，因此我们分析了大型注册数据以阐明这些关联。
我们在日本的71个中心进行了一项历史性队列研究，纳入服用维生素K拮抗剂（VKA）的NVAF门诊患者。负责医生可在随访期间根据其判断将VKA换为直接口服抗凝剂。我们将患者分为四个BMI组（kg/m²）：体重过轻（BMI＜18.5）、正常体重（18.5≤BMI＜25）、超重（25≤BMI＜30）和肥胖（30≤BMI）。使用Cox比例风险模型并对潜在混杂因素进行调整，估计每个BMI组相对于正常体重组对全因死亡、缺血性事件和出血事件等临床结局的影响。我们还构建了经多变量Cox比例风险模型调整的受限立方样条回归模型。我们纳入了6927例患者，包括体重过轻组（n = 386）、正常体重组（n = 3785）、超重组（n = 2174）和肥胖组（n = 582）。中位随访期为3.9年。在体重过轻组中，全因死亡和缺血性事件的调整后风险比（HR）分别为1.75（1.30 - 2.34）和1.61（1.04 - 2.50）。超重组的全因死亡HR为0.63（0.49 - 0.82）。受限立方样条回归模型证实，较低的BMI显示出全因死亡和缺血性事件的风险显著更高。
在服用OAC的NVAF患者中，体重过轻的患者比其他患者有更高的全因死亡和缺血性事件风险。超重患者的全因死亡风险较低。
