Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease Role of "Normal Weight Central Obesity"
Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease Role of "Normal Weight Central Obesity"
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DOI：
10.1016/j.jacc.2012.10.035
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发表时间：
2013-02-05
影响因子：
24
通讯作者：
Lopez-Jimenez, Francisco
中科院分区：
文献类型：
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作者：
Coutinho, Thais;Goel, Kashish;Lopez-Jimenez, Francisco
目的本研究旨在评估冠心病（CAD）患者的死亡风险，基于体重指数（BMI）和中心性肥胖的测量。背景在CAD患者中，死亡率与BMI呈反比（“肥胖悖论”）。相反，中心性肥胖与死亡率直接相关。由于这种双向的关系，我们假设，CAD患者BMI正常，但与中心性肥胖将有更差的生存率与其他组合的BMI和中心性adiposity.Methods的受试者相比，我们纳入了15,547名参与者与CAD谁参加了来自3大洲的5项研究。多变量分层Cox比例风险模型，调整潜在的混杂因素，用于评估死亡风险，根据不同的肥胖模式，结合BMI与措施的中心obesity.Results平均年龄为66岁，55%是男性。在平均4.7年的随访中，有4，699人死亡。体重正常但中心性肥胖的受试者的长期生存率最差：BMI为22 kg/m2且腰臀比（WHR）为0.98的人的死亡率高于BMI相似但WHR为0.89的人（风险比[HR]：1.10; 95%置信区间[CI]：1.05至1.17）; BMI为26 kg/m2，WHR为0.89的人（HR：1.20; 95% CI：1.09 - 1.31），而BMI为30 kg/m2和WHR为0.89的人（HR：1.61; 95% CI：1.39至1.86），而BMI为30 kg/m2、WHR为0.98的人（HR：1.27; 95% CI：1.18 ~ 1.39）（均P < 0.0001）。结论在冠心病患者中，正常体重伴中心性肥胖与死亡风险最高相关。（J Am科尔心脏病学杂志2013; 61：553-60）（C）美国心脏病学会基金会2013年
Objectives This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based on a combination of body mass index (BMI) and measures of central obesity.Background In CAD patients, mortality has been reported to vary inversely with BMI ("obesity paradox"). In contrast, central obesity is directly associated with mortality. Because of this bi-directional relationship, we hypothesized that CAD patients with normal BMI but with central obesity would have worse survival compared with subjects with other combinations of BMI and central adiposity.Methods We included 15,547 participants with CAD who took part in 5 studies from 3 continents. Multivariate stratified Cox-proportional hazard models that adjusted for potential confounders were used to assess mortality risk according to different patterns of adiposity that combined BMI with measures of central obesity.Results Mean age was 66 years; 55% were men. There were 4,699 deaths over a median follow-up of 4.7 years. Subjects with normal weight but central obesity had the worst long-term survival: a person with BMI of 22 kg/m(2) and waist-to-hip ratio (WHR) of 0.98 had higher mortality than a person with similar BMI but WHR of 0.89 (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.05 to 1.17); than a person with BMI of 26 kg/m(2) and WHR of 0.89 (HR: 1.20; 95% CI: 1.09 to 1.31), than in a person with BMI of 30 kg/m(2) and WHR of 0.89 (HR: 1.61; 95% CI: 1.39 to 1.86), and than a person with BMI of 30 kg/m(2) and WHR of 0.98 (HR: 1.27; 95% CI: 1.18 to 1.39) (p < 0.0001 for all).Conclusions In patients with CAD, normal weight with central obesity was associated with the highest risk of mortality. (J Am Coll Cardiol 2013; 61: 553-60) (C) 2013 by the American College of Cardiology Foundation