Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Aging (Albany NY). 2024 Jul 24;16(14):11359-11372. doi: 10.18632/aging.206018.
Several studies suggest an "obesity paradox," associating obesity with better cardiovascular outcomes in patients with type 2 diabetes mellitus (DM) or aortic stenosis (AS) compared to normal or underweight individuals. This study explores the impact of body mass index (BMI) on diabetic patients with AS.
Between 2014 and 2019, patients with DM who underwent echocardiography were analyzed. Outcomes included all-cause mortality, cardiovascular, and non-cardiovascular death. Patients were categorized as underweight, normal weight, or obese based on BMI (<18.5, 18.5 to 27, and >27 kg/m2, respectively).
Among 74,835 DM patients, 734 had AS. Normal weight comprised 65.5% (n=481), underweight 4.1% (N=30), and 30.4% were obese. Over a 6-year follow-up, underweight patients had significantly higher all-cause mortality (HR 1.96, 95% CI 1.22 - 3.14, p = 0.005), while obese patients had significantly lower mortality (HR 0.79, 95% CI 0.68 - 0.91, p=0.001) compared to the normal group. Regarding etiologies, underweight patients had a higher risk of non-cardiovascular death (HR 2.47, 95% CI 1.44-4.25, p = 0.001), while obese patients had a lower risk of cardiovascular death (HR 0.66, 95% CI 0.50-0.86, p=0.003). Subgroup analysis showed a consistent trend without significant interaction.
BMI significantly impacts mortality in DM patients with AS. Being underweight is associated with worse non-cardiovascular death, while obesity is linked to improved cardiovascular death outcomes.
一些研究表明，与正常体重或体重不足的个体相比，2 型糖尿病（DM）或主动脉瓣狭窄（AS）患者的肥胖与更好的心血管结局相关，这种现象被称为“肥胖悖论”。本研究旨在探讨 BMI 对合并 AS 的 DM 患者的影响。
本研究分析了 2014 年至 2019 年间接受超声心动图检查的 DM 患者。主要研究终点为全因死亡率、心血管死亡和非心血管死亡。根据 BMI（<18.5、18.5-27 和>27kg/m2）将患者分为体重不足、正常体重和肥胖。
在 74835 例 DM 患者中，734 例患有 AS。正常体重占 65.5%（n=481），体重不足占 4.1%（N=30），30.4%为肥胖。在 6 年的随访期间，与正常体重组相比，体重不足患者的全因死亡率显著更高（HR 1.96，95%CI 1.22-3.14，p=0.005），而肥胖患者的死亡率显著更低（HR 0.79，95%CI 0.68-0.91，p=0.001）。在病因学方面，体重不足患者非心血管死亡的风险更高（HR 2.47，95%CI 1.44-4.25，p=0.001），而肥胖患者心血管死亡的风险更低（HR 0.66，95%CI 0.50-0.86，p=0.003）。亚组分析显示，没有显著的交互作用，存在一致的趋势。
BMI 显著影响合并 AS 的 DM 患者的死亡率。体重不足与非心血管死亡增加相关，而肥胖与心血管死亡结局改善相关。
