Association Between Obesity and Mortality After Acute First-Ever Stroke The Obesity-Stroke Paradox
Association Between Obesity and Mortality After Acute First-Ever Stroke The Obesity-Stroke Paradox
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DOI：
10.1161/strokeaha.110.593434
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发表时间：
2011-01-01
期刊：
影响因子：
8.3
通讯作者：
Alevizaki, Maria
中科院分区：
文献类型：
--
作者：
Vemmos, Konstantinos;Ntaios, George;Alevizaki, Maria
背景和目的：关于肥胖和急性卒中患者生存率的数据有限。本研究的目的是调查肥胖和生存的急性首次中风患者之间的关联。方法患者进行了前瞻性研究的基础上，一个标准的诊断协议超过16年。在入院时、出院后7天、1个月、3个月和6个月进行评估，此后每年进行评估，直至卒中后10年。根据体重指数（BMI）将研究患者分为3组：正常体重（≥ 30 kg/m2）。随访期间的总生存率是主要终点。次要终点是研究期间的总体复合心血管事件。结果-根据我们的纳入标准，招募了2785例患者。根据BMI，1138例（40.9%）患者体重正常，1113例（41.0%）超重，504例（18.1%）肥胖。入院时的NIHSS评分（平均值，11.28 ± 8.65）在研究组之间没有差异。肥胖（96.4%; 95% CI，94.8%-97.9%）和超重患者（92.8%; 95% CI，91.2%-94.4%）的早期（第一周）生存率显著高于正常体重患者（90.2%; 95% CI，88.4%-92.0%）。同样，肥胖患者的10年生存率为52.5%（95%CI，46.4%-58.6%），超重患者为47.4%（95%CI，43.5%-51.3%），正常体重患者为41.5%（95%CI，39.7%-45.0%）（对数秩检验= 17.7; P < 0.0001）。超重（HR，0.82; 95% CI，0.71-0.94）和肥胖患者（HR，0.71; 95%CI，0.59-0.86）在调整所有混杂变量后，与正常体重患者相比，10年死亡率风险显著降低。与BMI正常的患者相比，肥胖和超重的中风患者具有显著更好的早期和长期存活率。（中风。2011;42：30-36.）
Background and Purpose-Limited data exist concerning obesity and survival in patients after acute stroke. The objective of this study was to investigate the association between obesity and survival in patients with acute first-ever stroke.Methods-Patients were prospectively investigated based on a standard diagnostic protocol over a period of 16 years. Evaluation was performed on admission, at 7 days, at 1, 3, and 6 months after discharge, and yearly thereafter for up to 10 years after stroke. The study patients were divided into 3 groups according to body mass index (BMI): normal weight (= 30 kg/m(2)). Overall survival during follow-up was the primary end point. The secondary end point was the overall composite cardiovascular events over the study period.Results-Based on our inclusion criteria, 2785 patients were recruited. According to BMI, 1138 (40.9%) patients were of normal weight, 1113 (41.0%) were overweight, and 504 (18.1%) were obese. NIHSS score on admission (mean, 11.28 +/- 8.65) was not different among the study groups. Early (first week) survival in obese (96.4%; 95% CI, 94.8%-97.9%) and overweight patients (92.8%; 95% CI, 91.2%-94.4%) was significantly higher compared to that of normal-weight patients (90.2%; 95% CI, 88.4%-92.0%). Similarly, 10-year survival was 52.5% (95% CI, 46.4%-58.6%) in obese, 47.4% (95% CI, 43.5%-51.3%) in overweight, and 41.5% (95% CI, 39.7%-45.0%) in normal-weight patients (log-rank test = 17.7; P < 0.0001). Overweight (HR, 0.82; 95% CI, 0.71-0.94) and obese patients (HR, 0.71; 95% CI, 0.59-0.86) had a significantly lower risk of 10-year mortality compared to normal-weight patients after adjusting for all confounding variables.Conclusions-Based on BMI estimation, obese and overweight stroke patients have significantly better early and long-term survival rates compared to those with normal BMI. (Stroke. 2011;42:30-36.)