Myocardial Injury, Obesity, and the Obesity Paradox: The ARIC Study.
Myocardial Injury, Obesity, and the Obesity Paradox: The ARIC Study.
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DOI：
10.1016/j.jchf.2016.10.010
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发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Deswal A
中科院分区：
文献类型：
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作者：
Pokharel Y;Sun W;Virani SS;Nambi V;Hoogeveen RC;Chang PP;Ndumele CE;Solomon SD;Bozkurt B;Selvin E;Ballantyne CM;Deswal A
研究心衰前心肌损伤是否可以解释不同体重组心衰后的死亡率差异。肥胖是HF的危险因素，但HF前肥胖与HF事件后死亡率较低相关。高敏肌钙蛋白T（hs-cTnT）是心肌损伤的敏感标志物，可预测HF事件和死亡率。根据HF前hs-cTnT水平（<和≥ 14 ng/L）对1279例HF住院患者进行分层，我们在ARIC研究中检查了HF前体重指数（BMI）与HF住院后死亡率的相关性。HF时的平均年龄为74岁（53%女性，27%黑人）。在校正模型（包括BMI）中，HF前hs-cTnT≥14 ng/L的个体发生HF后的死亡率高于hs-cTnT<14 ng/L的个体（HR 1.46，95% CI 1.18-1.80）。与正常体重组相比，超重组死亡率较低（HR 0.69，95% CI 0.48-0.98）和肥胖（HR 0.50，95% CI 0.35-0.72），hs-cTnT<14 ng/L; hs-cTnT ≥14 ng/L（超重：HR 0.50，95% CI 0.30-0.83;肥胖：HR 0.56，95% CI 0.34-0.91）（BMI和hs-cTnT之间的相互作用p=0.154）。当log hs-cTnT作为一个连续变量加入多变量模型中，并在敏感性分析中校正左心室肥大和高敏C反应蛋白时，肥胖和超重患者的较低死亡风险保持相似。虽然更大的预先存在的亚临床心肌损伤与事件HF住院后更高的死亡率相关，但这并不能解释HF中的肥胖悖论，这与亚临床心肌损伤无关。
To examine whether pre-heart failure (HF) myocardial injury explains the differential mortality after HF across weight categories. Obesity is a risk factor for HF, but pre-HF obesity is associated with lower mortality after incident HF. High-sensitivity Troponin T (hs-cTnT), a sensitive marker of myocardial injury, predicts incident HF and mortality. Stratifying 1279 individuals with incident HF hospitalizations by their pre-HF hs-cTnT levels (< and ≥ 14 ng/L), we examined the association of pre-HF body mass index (BMI) with mortality after incident HF hospitalization in the ARIC study. Mean age at HF was 74 years (53% women, 27% black). Individuals with pre-HF hs-cTnT≥14 ng/L had higher mortality after incident HF (HR 1.46, 95% CI 1.18-1.80) compared to individuals with hs-cTnT<14 ng/L in an adjusted model including BMI. Compared with normal weight, the mortality was lower in overweight (HR 0.69, 95% CI 0.48-0.98) and obese (HR 0.50, 95% CI 0.35-0.72) with hs-cTnT<14 ng/L; and in those with hs-cTnT ≥14 ng/L (overweight: HR 0.50, 95% CI 0.30-0.83; obese: HR 0.56, 95% CI 0.34-0.91) (interaction p=0.154 between BMI and hs-cTnT). The lower mortality risk in obese and overweight remained similar when log hs-cTnT was added as a continuous variable to a multivariable model and in sensitivity analyses adjusting for left ventricular hypertrophy and high-sensitivity C-reactive protein. Although greater pre-existing subclinical myocardial injury was associated with higher mortality after incident HF hospitalization, it did not explain the obesity paradox in HF, which was observed irrespective of subclinical myocardial injury.