Kim Chang-Yeon, Lee Jae Yong, Jung Hae Won
Department of Cardiology, Daegu Catholic Medical Center, Daegu, Korea.
Cardiovasc Diagn Ther. 2024 Aug 31;14(4):642-654. doi: 10.21037/cdt-24-27. Epub 2024 Jul 31.
Previous studies revealed a linear relationship between body mass index (BMI) and repeat coronary revascularization rate in patients who underwent percutaneous coronary intervention (PCI). However, this relationship has not been demonstrated in Korean patients who meet old and new target low-density lipoprotein cholesterol (LDL-C) levels of Korean dyslipidemia guidelines. Therefore, we conducted this study to find out the effect of BMI on repeat coronary revascularization rate in patients with LDL-C <55 mg/dL and patients with LDL-C <70 mg/dL.
This cohort study was followed for 42 months in Daegu Catholic Medical Center, Korea. We included 429 patients with LDL-C <70 mg/dL 1 year after PCI. We compared repeat revascularization rates using Kaplan-Meier survival curves between the normal weight group (18.5 kg/m ≤ BMI < 23 kg/m) and the pre-obesity and obesity group (23 kg/m ≤ BMI) in patients with LDL-C <55 mg/dL and patients with LDL-C <70 mg/dL.
During a follow-up period, there was no significant difference in repeat coronary revascularization-free survival between a group with LDL-C <55 mg/dL and a group with LDL-C <70 mg/dL (79.6% 76.2%, P=0.32). In normal weight patients, LDL-C <55 mg/dL group showed higher repeat coronary revascularization-free survival than LDL-C <70 mg/dL group (89.3% 77.1%, P=0.05). There was no significant difference in repeat revascularization-free survival between the normal weight group and the pre-obesity and obesity group in patients with LDL-C <70 mg/dL (77.1% 75.7%, P=0.67). However, the normal weight group showed significantly higher repeat revascularization-free survival compared to the pre-obesity and obesity group in patients with LDL-C <55 mg/dL (89.3% 74.3%, P=0.03). Normal body weight and LDL-C <55 mg/dL [hazard ratio (HR): 0.421, 95% confidence interval (CI): 0.193-0.916, P=0.02] was the only independent predictor for repeat revascularization.
In Korean PCI patients with normal body weight whose LDL-C level is less than 70 mg/dL, but more than 55 mg/dL, should be treated with more intensive therapy to lower LDL-C to less than 55 mg/dL. For obese patients who have succeeded in reducing LDL-C below 55 mg/dL, it seems that weight loss should be attempted to a normal body weight level.
既往研究显示，接受经皮冠状动脉介入治疗（PCI）的患者，其体重指数（BMI）与再次冠状动脉血运重建率之间存在线性关系。然而，在符合韩国血脂异常指南新旧目标低密度脂蛋白胆固醇（LDL-C）水平的韩国患者中，这种关系尚未得到证实。因此，我们开展了本研究，以探究BMI对LDL-C<55mg/dL的患者和LDL-C<70mg/dL的患者再次冠状动脉血运重建率的影响。
本队列研究在韩国大邱天主教医疗中心进行了42个月。我们纳入了PCI术后1年LDL-C<70mg/dL的429例患者。我们使用Kaplan-Meier生存曲线比较了LDL-C<55mg/dL的患者和LDL-C<70mg/dL的患者中正常体重组（18.5kg/m≤BMI<23kg/m）与肥胖前期和肥胖组（23kg/m≤BMI）的再次血运重建率。
在随访期间，LDL-C<55mg/dL组和LDL-C<70mg/dL组之间的无再次冠状动脉血运重建生存率无显著差异（79.6%对76.2%，P=0.32）。在正常体重患者中，LDL-C<55mg/dL组的无再次冠状动脉血运重建生存率高于LDL-C<70mg/dL组（89.3%对77.1%，P=0.05）。在LDL-C<70mg/dL的患者中，正常体重组与肥胖前期和肥胖组之间的无再次血运重建生存率无显著差异（77.1%对75.7%，P=0.67）。然而，在LDL-C<55mg/dL的患者中，正常体重组的无再次血运重建生存率显著高于肥胖前期和肥胖组（89.3%对74.3%，P=0.03）。正常体重且LDL-C<55mg/dL[风险比（HR）：0.421，95%置信区间（CI）：0.193-0.916，P=0.02]是再次血运重建的唯一独立预测因素。
在韩国LDL-C水平低于70mg/dL但高于55mg/dL的正常体重PCI患者中，应采用更强化的治疗将LDL-C降至55mg/dL以下。对于成功将LDL-C降至55mg/dL以下的肥胖患者，似乎应尝试减重至正常体重水平。
