Meta-Analysis of the Relation of Body Mass Index to All-Cause and Cardiovascular Mortality and Hospitalization in Patients With Chronic Heart Failure
Meta-Analysis of the Relation of Body Mass Index to All-Cause and Cardiovascular Mortality and Hospitalization in Patients With Chronic Heart Failure
复制标题
DOI：
10.1016/j.amjcard.2015.02.024
复制
发表时间：
2015-05-15
影响因子：
2.8
通讯作者：
Lazar, Jason M.
中科院分区：
文献类型：
--
作者：
Sharma, Abhishek;Lavie, Carl J.;Lazar, Jason M.
临床研究表明，慢性心力衰竭(HF)患者存在“肥胖悖论”，即与正常体重参考组相比，体重指数(BMI)评分升高的患者死亡率降低。本研究的目的是通过对已发表研究的系统回顾和荟萃分析，探讨BMI与慢性心力衰竭患者全因死亡率、心血管(CV)死亡率和住院时间的关系。在PubMed、Cumulative Index to Nursing and Allied Health Documents、Cochrane Central、Scope us、Web of Science和Embase上搜索不同BMI类别(=35 kg/m(2)[严重肥胖])心力衰竭患者的总死亡率、心脏死亡率和住院风险的研究。事件发生率的比较使用相对风险(RR)的森林图，使用假设研究间异质性的随机效应模型。两名研究调查人员独立审查了检索到的124份报告，确定了6份进行最终分析(n=22,807)。平均随访2.85年后，体重指数低的患者发生不良事件的风险最高：总死亡率RR 1.27(95%可信区间1.17~1.37)，CV死亡率RR 1.20(95%CI 1.01~1.43)，住院RR 1.19(95%CI 1.09~1.30)。超重患者的心血管死亡率和住院风险最低(RR分别为0.79，95%CI为0.70~0.90，RR分别为0.92，95%CI为0.86~0.97)。肥胖程度的增加对心血管疾病死亡率(肥胖组和重度肥胖组的RR分别为0.82，95%CI 0.64~1.05，RR=0.71，95%CI=0.50~1.01)和住院治疗(RR=0.99，95%CI=0.92~1.07，RR=1.28，95%CI=0.88~1.87)均无统计学意义。总而言之，低BMI定义的慢性心力衰竭患者的总死亡率和心血管死亡率和住院风险最高，而超重者的心血管死亡率和住院风险最低。(C)2015 Elsevier Inc.保留所有权利。
Clinical studies have indicated the existence of an "obesity paradox" in patients with chronic heart failure (HF), that is, reduced mortality in patients who have elevated body mass index (BMI) scores compared with normal-weight reference groups. The aim of this study was to investigate the relation of BMI with all-cause and cardiovascular (CV) mortality and hospitalization in patients with chronic HF though a systematic review and meta-analysis of published research. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central, Scopus, web of science and Embase were searched for studies reporting rates of total mortality, cardiac mortality, and risk for hospitalization in patients with HF in various BMI categories (= 35 kg/m(2) [severely obese]). Event rates were compared using a forest plot of relative risk (RR) using a random-effects model assuming interstudy heterogeneity. Two study investigators independently reviewed the 124 reports retrieved and identified 6 for final analyses (n = 22,807). After a mean follow-up period of 2.85 years, the risk for adverse events was highest in patients with low BMIs: total mortality RR 1.27 (95% confidence interval [CI] 1.17 to 1.37), CV mortality RR 1.20 (95% CI 1.01 to 1.43), and hospitalization RR 1.19 (95% CI 1.09 to 1.30). Risk for CV mortality and hospitalization was lowest in overweight patients (RR 0.79, 95% CI 0.70 to 0.90, and RR 0.92, 95% CI 0.86 to 0.97, respectively). Increasing degree of obesity failed to achieve a statistically significant effect on CV mortality (RR 0.82, 95% CI 0.64 to 1.05, and RR 0.71, 95% CI 0.50 to 1.01, for obese and severely obese, respectively) and on hospitalization (RR 0.99, 95% CI 0.92 to 1.07, and RR 1.28, 95% CI 0.88 to 1.87, for obese and severely obese, respectively). In conclusion, risk for total mortality and CV mortality and hospitalization was highest in patients with chronic HF who were underweight as defined by low BMI, whereas risk for CV mortality and hospitalization was lowest in overweight subjects. (C) 2015 Elsevier Inc. All rights reserved.