Sungur Aylin, Sungur Mustafa Azmi, Simsek Baris, Tezen Ozan, Yumurtas Ahmet Cagdas, Inan Duygu, Genc Duygu, Can Fatma, Karabay Can Yucel
Department of Cardiology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkiye.
Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkiye.
North Clin Istanb. 2023 Sep 13;10(5):567-574. doi: 10.14744/nci.2023.87259. eCollection 2023.
Obesity is a global health problem that increases the risk of coronary artery disease (CAD). However in studies, it has been observed that when the disease develops, obese patients have a more favorable prognosis than leaner patients. This is called the "obesity paradox." This study aims to evaluate the effect of obesity assessed with body fat percentage (BFP) and relative fat mass (RFM) besides body mass index (BMI) on infarct size (IS) estimated from peak creatine kinase-MB (CK-MB) levels in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
Patients with a diagnosis of NSTEMI who underwent coronary angiography between January 2017 and January 2022 were retrospectively evaluated. Patients without available anthropometric data to calculate BMI, BFP, and RFM and serial CK-MB measurements were excluded from the study. BMI was calculated using weight(kg)/(height[m]) formula. Patients were dichotomized as obese (BMI≥30 kg/m) and non-obese (BMI<30 kg/m) to compare baseline characteristics. BFP and RFM were calculated from anthropometric data. Linear regression analysis was performed to define predictors of IS.
Final study population consisted of 748 NSTEMI patients (mean age was 59.3±11.2 years, 76.3% were men, 36.1% of the patients were obese). Obese patients were more likely to be female, hypertensive, and diabetic. Smoking was less frequently observed in obese patients. Peak CK-MB levels were similar among groups. Obese patients had higher in-hospital left ventricular ejection fraction, and less severe CAD was observed in coronary angiographies of these patients. Multivariable regression analysis identified diabetes mellitus, systolic blood pressure, white blood cell count, hemoglobin, and BFP (β=-4.8, 95% CI=-8.7; -0.3, p=0.03) as independent predictors of IS.
Higher BFP is associated with smaller IS in NSTEMI patients. These findings support the obesity paradox in this patient group, but further, randomized controlled studies are required.
肥胖是一个全球性的健康问题，会增加冠状动脉疾病（CAD）的风险。然而，在研究中观察到，当疾病发生时，肥胖患者的预后比瘦患者更有利。这被称为“肥胖悖论”。本研究旨在评估除体重指数（BMI）外，用体脂百分比（BFP）和相对脂肪量（RFM）评估的肥胖对非ST段抬高型心肌梗死（NSTEMI）患者根据肌酸激酶-MB（CK-MB）峰值水平估计的梗死面积（IS）的影响。
对2017年1月至2022年1月期间接受冠状动脉造影的NSTEMI诊断患者进行回顾性评估。没有可用人体测量数据来计算BMI、BFP和RFM以及连续CK-MB测量值的患者被排除在研究之外。BMI使用体重（kg）/（身高[m]）公式计算。将患者分为肥胖（BMI≥30 kg/m²）和非肥胖（BMI<30 kg/m²）两组以比较基线特征。BFP和RFM根据人体测量数据计算。进行线性回归分析以确定IS的预测因素。
最终研究人群包括748例NSTEMI患者（平均年龄为59.3±11.2岁，76.3%为男性，36.1%的患者肥胖）。肥胖患者更可能为女性、患有高血压和糖尿病。肥胖患者吸烟较少见。各组间CK-MB峰值水平相似。肥胖患者住院时左心室射血分数较高，且在这些患者的冠状动脉造影中观察到CAD较轻。多变量回归分析确定糖尿病、收缩压、白细胞计数、血红蛋白和BFP（β=-4.8，95%CI=-8.7；-0.3，p=0.03）为IS的独立预测因素。
较高的BFP与NSTEMI患者较小的IS相关。这些发现支持了该患者群体中的肥胖悖论，但还需要进一步的随机对照研究。
