Zhong Qiaoqing, Yunus Rayaan A, Sohail Mahnoor, Saeed Shirin, Rehman Taha A, Khan Adnan A, Russ Elizabeth, Schermerhorn Marc, Mahmood Feroze, Matyal Robina
Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, China.
Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Ann Vasc Surg. 2025 Jan;110(Pt B):347-361. doi: 10.1016/j.avsg.2024.07.099. Epub 2024 Aug 7.
Numerous studies have indicated that increased obesity in patients with established peripheral artery disease (PAD) is inversely associated with disease prognosis, a phenomenon coined as the "obesity paradox". A major cause of criticism in studies investigating the obesity paradox is the use of body mass index (BMI) as a surrogate marker in defining and quantifying the degree or severity of obesity. We conducted a retrospective review to verify whether the obesity paradox persists in patients with PAD when using body surface area (BSA) as an alternative anthropometric measure.
Patients undergoing surgery (open or endovascular) for PAD between January 2009 and March 2020 were identified from the Vascular Quality Initiative (VQI) national database. The association between BSA or BMI and risk of postoperative complications was evaluated using logistic regression and restricted cubic spline analysis, both of which were adjusted for demographic and comorbid risk predictors. When analyzing BSA and BMI as categorical variables, patients were grouped according to BSA quintiles and the World Health Organization (WHO) BMI categories.
A total of 130,428 patients were included based on our eligibility criteria, of which 85,394 (65.5%) were men. Patients were typically hypertensive (87.8%), diabetic (50.4%), and overweight (63.0% over 25 kg/m). Patients with a high BMI or BSA typically presented at a younger age and with greater preoperative administration of drugs (statin, angiotensin converting enzyme inhibitor, anticoagulant, and beta blocker). Our results indicate that BSA and BMI are inversely associated with postoperative risk of all-cause morbidity, mortality, and cardiac complications. This finding was displayed when analyzing BMI or BSA as a continuous variable or when indexing patients into BMI or BSA groups.
Our data suggests that the obesity paradox persists in patients with PAD when using either BMI or BSA as anthropometric measures. Future studies with a prospective design and utilizing newer anthropometric indices should be conducted to fully verify the presence of this phenomenon.
大量研究表明，已确诊外周动脉疾病（PAD）患者肥胖程度增加与疾病预后呈负相关，这一现象被称为“肥胖悖论”。在研究肥胖悖论时，受到批评的一个主要原因是使用体重指数（BMI）作为定义和量化肥胖程度或严重程度的替代指标。我们进行了一项回顾性研究，以验证当使用体表面积（BSA）作为替代人体测量指标时，肥胖悖论在PAD患者中是否依然存在。
从血管质量倡议（VQI）国家数据库中识别出2009年1月至2020年3月期间因PAD接受手术（开放手术或血管内手术）的患者。使用逻辑回归和受限立方样条分析评估BSA或BMI与术后并发症风险之间的关联，二者均针对人口统计学和合并症风险预测因素进行了调整。在将BSA和BMI作为分类变量进行分析时，根据BSA五分位数和世界卫生组织（WHO）的BMI类别对患者进行分组。
根据我们的纳入标准，共纳入130428例患者，其中85394例（65.5%）为男性。患者通常患有高血压（87.8%）、糖尿病（50.4%）且超重（63.0%超过25kg/m²）。BMI或BSA较高的患者通常发病年龄较轻，术前用药（他汀类药物、血管紧张素转换酶抑制剂、抗凝剂和β受体阻滞剂）较多。我们的结果表明，BSA和BMI与术后全因发病、死亡和心脏并发症风险呈负相关。在将BMI或BSA作为连续变量进行分析，或将患者分为BMI或BSA组时，均显示出这一结果。
我们的数据表明，当使用BMI或BSA作为人体测量指标时，肥胖悖论在PAD患者中依然存在。未来应开展具有前瞻性设计并采用更新人体测量指标的研究，以充分验证这一现象的存在。
