脂蛋白水平对心力衰竭患者 BMI 和心血管结局的中介效应分析。

Mediation effect analysis of lipoprotein levels on BMI and cardiovascular outcomes in patients with heart failure.

机构信息

Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Zhongshan Road, Nanjing, 210008, China.

Department of Cardiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road, Nanjing, 210008, China.

出版信息

BMC Cardiovasc Disord. 2024 Oct 12;24(1):553. doi: 10.1186/s12872-024-04155-9.

DOI:10.1186/s12872-024-04155-9

PMID:39395939

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11470738/

Abstract

BACKGROUND

Among heart failure patients with obesity, the prognosis is better than those with normal weight, a phenomenon known as the obesity paradox. However, it is unclear whether lipoprotein levels play a mediating role in the machine of the obesity paradox.

METHODS

The study included 1663 heart failure patients hospitalized from January, 2019 through August, 2022. Kaplan-Meier survival analysis and Log-rank tests were performed for three endpoints in order to determine cumulative event-free survival. We investigated the correlation between Body Max Index (BMI) and outcomes by multifactorial Cox models. Mediation analysis was applied to study the presence and magnitude of mediation effects of triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1 and apolipoprotein B, with the association between BMI and endpoints.

RESULTS

In MACCEs, the median follow-up period was 679 days. In Cox model, compared with the underweight group, a high BMI level was significantly associated with lower all-cause mortality (HR=0.47, 95%CI 0.31~~0.69, p<0.001, obese vs underweight), cardiovascular mortality (HR=0.46, 95%CI 0.30~~0.73, p<0.001, obese vs underweight) and the incidence of MACCEs (HR=0.68, 95%CI 0.53~~0.88, p=0.003, obese vs underweight). Mediation analysis revealed that TG was the strongest mediator between BMI and endpoints, with proportions of mediated effects of 6.6% (95%CI 2.2%~~18.0%, p=0.0258, in all-cause death),7.0% (95%CI 2.3%~~18.9%, p=0.0301, in cardiovascular death) and 10.2% (95%CI 3.3%~~27.4%, p=0.0185, in MACCEs).

CONCLUSIONS

There is an "obesity paradox" in patients with heart failure, and lipoprotein levels especially triglyceride mediate the association between BMI and cardiovascular outcomes.

摘要

背景

在肥胖的心力衰竭患者中，其预后优于体重正常的患者，这种现象被称为肥胖悖论。然而，脂蛋白水平是否在肥胖悖论的机制中起中介作用尚不清楚。

方法

本研究纳入了 2019 年 1 月至 2022 年 8 月期间住院的 1663 例心力衰竭患者。采用 Kaplan-Meier 生存分析和 Log-rank 检验来确定三个终点的累积无事件生存率。我们通过多因素 Cox 模型研究了 Body Max Index（BMI）与结局之间的相关性。通过中介分析研究了甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白 A1 和载脂蛋白 B 与 BMI 和终点之间的关联的存在和程度。

结果

在 MACCEs 中，中位随访时间为 679 天。在 Cox 模型中，与体重不足组相比，高 BMI 水平与全因死亡率降低显著相关（HR=0.47，95%CI 0.31~~0.69，p<0.001，肥胖 vs 体重不足）、心血管死亡率（HR=0.46，95%CI 0.30~~0.73，p<0.001，肥胖 vs 体重不足）和 MACCEs 的发生率（HR=0.68，95%CI 0.53~~0.88，p=0.003，肥胖 vs 体重不足）。中介分析显示，TG 是 BMI 与终点之间最强的中介物，中介效应的比例分别为 6.6%（95%CI 2.2%~~18.0%，p=0.0258，全因死亡）、7.0%（95%CI 2.3%~~18.9%，p=0.0301，心血管死亡）和 10.2%（95%CI 3.3%~~27.4%，p=0.0185，MACCEs）。