Obesity paradox in group 1 pulmonary hypertension: analysis of the NIH-Pulmonary Hypertension registry.
Obesity paradox in group 1 pulmonary hypertension: analysis of the NIH-Pulmonary Hypertension registry.
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DOI：
10.1038/ijo.2017.45
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发表时间：
2017-08
期刊：
影响因子：
--
通讯作者：
Bilchick KC
中科院分区：
文献类型：
--
作者：
Mazimba S;Holland E;Nagarajan V;Mihalek AD;Kennedy JLW;Bilchick KC
“肥胖悖论”是指肥胖患者比正常体重患者有更好的结果。在多种心血管疾病中都观察到了这一现象，但肺动脉高压（PH）中肥胖悖论的证据仍然很少。我们根据体重指数 (BMI) 将 267 名来自国家健康研究所 - PH 登记处的患者分为五组：体重不足、体重正常、超重、肥胖和病态肥胖。使用 X2 统计数据比较 BMI 组的死亡率。使用 PH 连接 (PHC) 风险方程计算五年死亡概率，并使用 Cox 比例风险回归和 Kaplan-Meier (KM) 生存曲线将该模型与 BMI 组进行比较。患者的中位年龄为 39 岁（四分位数范围 30-50 岁），中位 BMI 为 23.4 kg m−2 (21.0-26.8 kg m−2)，5 年总死亡率为 50.2%。我们发现生存率和 1 年死亡率之间存在 U 形关系，其中超重患者的 1 年生存率最高。 KM 曲线显示，超重患者的生存率最高，其次是肥胖和病态肥胖患者，正常体重和体重不足患者的生存率最差（对数秩 P = 0.0008）。在 Cox 比例风险分析中，即使在调整 PHC 风险方程后，BMI 的增加也是生存改善的高度显着预测因子，死亡风险比为 0.921/kg m−2（95% 置信区间：0.886–0.954）（P < 0.0001）。我们观察到，超重患者的生存率最高，这与其说是“肥胖悖论”，不如说是“超重悖论”。这对第 1 组 PH 患者的风险分层和预后具有影响。
The ‘obesity paradox’ refers to the fact that obese patients have better outcomes than normal weight patients. This has been observed in multiple cardiovascular conditions, but evidence for obesity paradox in pulmonary hypertension (PH) remains sparse. We categorized 267 patients from the National Institute of Health-PH registry into five groups based on body mass index (BMI): underweight, normal weight, overweight, obese and morbidly obese. Mortality was compared in BMI groups using the X2 statistic. Five-year probability of death using the PH connection (PHC) risk equation was calculated, and the model was compared with BMI groups using Cox proportional hazards regression and Kaplan-Meier (KM) survival curves. Patients had a median age of 39 years (interquartile range 30–50 years), a median BMI of 23.4 kg m −2 (21.0–26.8 kg m−2) and an overall mortality at 5 years of 50.2%. We found a U-shaped relationship between survival and 1-year mortality with the best 1-year survival in overweight patients. KM curves showed the best survival in the overweight, followed by obese and morbidly obese patients, and the worst survival in normal weight and underweight patients (log-rank P = 0.0008). In a Cox proportional hazards analysis, increasing BMI was a highly significant predictor of improved survival even after adjustment for the PHC risk equation with a hazard ratio for death of 0.921 per kg m−2 (95% confidence interval: 0.886–0.954) (P < 0.0001). We observed that the best survival was in the overweight patients, making this more of an ‘overweight paradox’ than an ‘obesity paradox’. This has implications for risk stratification and prognosis in group 1 PH patients.
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影响因子：
2.6
作者：
Bogaard HJ;Al Husseini A;Farkas L;Farkas D;Gomez-Arroyo J;Abbate A;Voelkel NF
通讯作者：
Voelkel NF
影响因子：
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作者：
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影响因子：
8.9
作者：
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通讯作者：
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影响因子：
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作者：
Frost, Adaani E.;Farber, Harrison W.;McGoon, Michael D.
通讯作者：
McGoon, Michael D.