Lin Ting-Yu, Leu Hsin-Bang
School of Medicine, National Yang Ming Chiao Tung University.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei.
Acta Cardiol Sin. 2025 Jan;41(1):82-93. doi: 10.6515/ACS.202501_41(1).20241021B.
The obesity paradox refers to lower mortality rates among overweight or obese individuals within certain populations. However, whether this paradox is applicable to patients undergoing percutaneous coronary intervention (PCI) remains unclear.
A total of 5,427 patients with coronary artery disease (CAD) who underwent successful PCI between 2005 and 2015 were enrolled. The association between body mass index (BMI) and future adverse cardiovascular events post PCI was analyzed. The study endpoints encompassed total cardiovascular (CV) events, including cardiac death, nonfatal myocardial infarction (MI), ischemic stroke, and hospitalization for congestive heart failure (CHF).
Over an average follow-up period of 65.1 ± 32.1 months, 942 patients (17.4%) had CV events, including 200 CV deaths (3.7%), 294 acute MIs (5.4%), 111 ischemic strokes (2.0%), 469 CHF hospitalizations (8.6%), and 1,098 revascularizations (20.2%). A J-shaped relationship between BMI and future adverse events was observed, in which individuals with a BMI of 25.0-29.9 kg/m had significantly lower risks of total CV events [hazard ratio (HR) = 0.84, 95% confidence interval (CI) = 0.72-0.98], major adverse cardiovascular events (HR = 0.76, 95% CI = 0.63-0.93), acute MI (HR = 0.76, 95% CI = 0.58-1.00), and ischemic stroke (HR = 0.61, 95% CI = 0.39-0.95), compared to those with a BMI of 22.0-24.9 kg/m.
We found a J-shaped relationship between baseline BMI and future adverse events in CAD patients undergoing PCI. Overweight individuals (BMI 25.0-29.9 kg/m) had the lowest future risk of total CV events compared to those with a normal BMI (22.0-24.9 kg/m).
肥胖悖论是指特定人群中超重或肥胖个体的死亡率较低。然而，这一悖论是否适用于接受经皮冠状动脉介入治疗（PCI）的患者仍不清楚。
纳入2005年至2015年间共5427例成功接受PCI的冠状动脉疾病（CAD）患者。分析体重指数（BMI）与PCI术后未来不良心血管事件之间的关联。研究终点包括总的心血管（CV）事件，包括心源性死亡、非致死性心肌梗死（MI）、缺血性卒中以及因充血性心力衰竭（CHF）住院。
在平均65.1±32.1个月的随访期内，942例患者（17.4%）发生了CV事件，包括200例CV死亡（3.7%）、294例急性MI（5.4%）、111例缺血性卒中（2.0%）、469例CHF住院（8.6%）以及1098例血运重建（20.2%）。观察到BMI与未来不良事件之间呈J形关系，其中BMI为25.0-29.9kg/m的个体发生总的CV事件的风险显著较低[风险比（HR）=0.84，95%置信区间（CI）=0.72-0.98]，主要不良心血管事件（HR=0.76，95%CI=0.63-0.93）、急性MI（HR=0.76，95%CI=0.58-1.00）以及缺血性卒中（HR=0.61，95%CI=0.39-0.95），与BMI为22.0-24.9kg/m的个体相比。
我们发现接受PCI的CAD患者基线BMI与未来不良事件之间呈J形关系。与BMI正常（22.0-24.9kg/m）的个体相比，超重个体（BMI 25.0-29.9kg/m）未来发生总的CV事件的风险最低。
