Association of body mass index with mortality and cardiovascular events for patients with coronary artery disease: a systematic review and meta-analysis
Association of body mass index with mortality and cardiovascular events for patients with coronary artery disease: a systematic review and meta-analysis
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DOI：
10.1136/heartjnl-2014-307119
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发表时间：
2015-10-01
期刊：
影响因子：
5.7
通讯作者：
Mauri, Laura
中科院分区：
文献类型：
--
作者：
Wang, Zhi Jian;Zhou, Yu Jie;Mauri, Laura
目的：肥胖与冠心病（CAD）患者预后之间的关系尚不明确。我们对这些患者的体重指数（BMI）对死亡率和心血管事件的影响进行了荟萃分析。方法：我们确定了基于BMI对冠心病患者死亡率或心血管事件进行风险估计的研究。获得了5个BMI组的相对风险总结估计：体重不足、体重正常、超重、肥胖和II/III级肥胖。死亡率按短期（6个月）单独分析。结果共纳入89项研究，1 300 794例患者。平均随访时间为3.2年。以正常体重为参照，体重不足与较高的短期死亡率（2.24(1.85至2.72)）和长期死亡率（1.70(1.56至1.86)）相关，超重和肥胖均与较低的短期死亡率相关（0.69(0.64至0.75)）；0.68(0.61 ~ 0.75))和长期死亡率(0.78 (0.74 ~ 0.82)；0.79(0.73 ~ 0.85))，但5年后肥胖的长期获益消失（0.99(0.91 ~ 1.08)）。II/III级肥胖在短期内与较低的死亡风险相关（0.76(0.62至0.91)），但在5年随访后与较高的风险相关（1.25(1.14至1.38)）。在不同的治疗策略中，心血管死亡率也出现了类似的j型模式。meta回归发现BMI和死亡率风险之间的负相关随着随访时间的延长而减弱。结论：我们的数据支持冠心病患者死亡率与BMI呈j型关系。现有文献的局限性保证了未来研究的更好设计。
Objectives The association between obesity and prognosis in patients with coronary artery disease (CAD) remains uncertain. We undertook a meta-analysis for the effects of body mass index (BMI) on mortality and cardiovascular events in these patients.Methods We identified studies that provided risk estimates for mortality or cardiovascular events on the basis of BMI in patients with CAD. Summary estimates of relative risks were obtained for five BMI groups: underweight, normal-weight, overweight, obese and grade II/III obese. Mortality was analysed separately as short-term (= 6 months).Results Data from 89 studies with 1 300 794 patients were included. Mean follow-up of long-term estimates was 3.2 years. Using normal-weight as the reference, underweight was associated with higher risk of short-term mortality (2.24 (1.85 to 2.72)) and long-term mortality (1.70 (1.56 to 1.86)), overweight and obesity were both associated with lower risk of short-term mortality (0.69 (0.64 to 0.75); 0.68 (0.61 to 0.75)) and long-term mortality (0.78 (0.74 to 0.82); 0.79 (0.73 to 0.85)), but the long-term benefit of obesity disappeared after 5 years of follow-up (0.99 (0.91 to 1.08)). Grade II/III obesity was associated with lower risk of mortality in the short term (0.76 (0.62 to 0.91)) but higher risk after 5 years of follow-up (1.25 (1.14 to 1.38)). The similar J-shaped pattern was also seen for cardiovascular mortality and across different treatment strategies. Meta-regression found an attenuation of the inverse association between BMI and risk of mortality over longer follow-up.Conclusions Our data support a J-shaped relationship between mortality and BMI in patients with CAD. The limitation of current literature warrants better design of future studies.