High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox.
High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox.
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DOI：
10.1186/s12877-020-01950-9
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发表时间：
2021-01-06
期刊：
影响因子：
4.1
通讯作者：
Miura T
中科院分区：
文献类型：
--
作者：
Ohori K;Yano T;Katano S;Kouzu H;Honma S;Shimomura K;Inoue T;Takamura Y;Nagaoka R;Koyama M;Nagano N;Fujito T;Nishikawa R;Ishigo T;Watanabe A;Hashimoto A;Miura T
虽然高体重指数（BMI）是心力衰竭（HF）的一个危险因素，但BMI较高的HF患者死亡率低于BMI正常或较低的HF患者，这种现象被称为“肥胖悖论”。然而，身体成分（即脂肪或肌肉量）与HF临床结局之间的关系仍不清楚。
我们回顾性分析了198例连续的HF患者的数据（年龄76岁；男性占49%）。纳入因HF诊断和治疗入住我院并接受双能X线吸收法扫描的患者，不考虑左心室射血分数（LVEF）类别。肌肉减少定义为男性四肢骨骼肌质量指数<7.0 kg/m²，女性<5.4 kg/m²。体脂百分比增加（FM增加）定义为男性体脂百分比>25%，女性>30%。
患者的中位年龄为76岁（四分位间距[IQR]，67 - 82岁），其中49%为男性。中位LVEF为47%（IQR，33 - 63%），33%的患者为射血分数降低的心力衰竭。入选患者中分别有58%和67%出现FM增加和肌肉减少。在180天的随访期间，32例患者（16%）发生心脏事件，定义为心脏死亡或因HF恶化或心律失常再入院。Kaplan - Meier生存曲线显示，FM增加的患者心脏事件发生率低于FM未增加的患者（11.4%对22.6%，p = 0.03）。有和无肌肉减少的患者心脏事件发生率的Kaplan - Meier曲线无差异（16.5%对15.4%，p = 0.93）。在多变量Cox回归分析中，调整年龄、性别、糖尿病、肌肉减少和肾功能后，FM增加与较低的心脏事件发生率独立相关（风险比：0.45，95%置信区间：0.22 - 0.93）。
高体脂百分比与HF患者短期心脏事件风险较低相关。
网络版包含补充材料，可在10.1186/s12877 - 020 - 01950 - 9获取。
Although high body mass index (BMI) is a risk factor of heart failure (HF), HF patients with a higher BMI had a lower mortality rate than that in HF patients with normal or lower BMI, a phenomenon that has been termed the “obesity paradox”. However, the relationship between body composition, i.e., fat or muscle mass, and clinical outcome in HF remains unclear. We retrospectively analyzed data for 198 consecutive HF patients (76 years of age; males, 49%). Patients who were admitted to our institute for diagnosis and management of HF and received a dual-energy X-ray absorptiometry scan were included regardless of left ventricular ejection fraction (LVEF) categories. Muscle wasting was defined as appendicular skeletal muscle mass index < 7.0 kg/m2 in males and < 5.4 kg/m2 in females. Increased percent body fat mass (increased FM) was defined as percent body fat > 25% in males and > 30% in females. The median age of the patients was 76 years (interquartile range [IQR], 67–82 years) and 49% of them were male. The median LVEF was 47% (IQR, 33–63%) and 33% of the patients had heart failure with reduced ejection fraction. Increased FM and muscle wasting were observed in 58 and 67% of the enrolled patients, respectively. During a 180-day follow-up period, 32 patients (16%) had cardiac events defined as cardiac death or readmission by worsening HF or arrhythmia. Kaplan-Meier survival curves showed that patients with increased FM had a lower cardiac event rate than did patients without increased FM (11.4% vs. 22.6%, p = 0.03). Kaplan-Meier curves of cardiac event rates did not differ between patients with and those without muscle wasting (16.5% vs. 15.4%, p = 0.93). In multivariate Cox regression analyses, increased FM was independently associated with lower cardiac event rates (hazard ratio: 0.45, 95% confidence interval: 0.22–0.93) after adjustment for age, sex, diabetes, muscle wasting, and renal function. High percent body fat mass is associated with lower risk of short-term cardiac events in HF patients. The online version contains supplementary material available at 10.1186/s12877-020-01950-9.
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