The Obesity Paradox and Heart Failure: A Systematic Review of a Decade of Evidence.
The Obesity Paradox and Heart Failure: A Systematic Review of a Decade of Evidence.
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DOI：
10.1155/2016/9040248
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发表时间：
2016
影响因子：
3.3
通讯作者：
Eseyin OR
中科院分区：
文献类型：
--
作者：
Oga EA;Eseyin OR
科学界一致认为，肥胖会增加心血管疾病的风险，包括心力衰竭。然而，在已经患有心力衰竭的人中，肥胖者的结果似乎比瘦人更好：这被称为肥胖悖论，其机制尚不清楚。本研究系统地回顾了心力衰竭死亡率（和生存率）与体重状况之间关系的证据。根据PRISMA方案检索PubMed/MEDLINE和EMBASE数据库。初步检索确定了9879篇潜在相关论文，其中10项研究符合纳入标准。1项研究为随机临床试验，9项为观察性队列研究：6项前瞻性研究和3项回顾性研究。所有研究均使用BMI、WC或TSF作为体脂和NYHA心力衰竭分类的指标，并将死亡作为单一结局作为研究终点。纳入综述的所有研究均为纵向研究。所有十项研究都报告称，与正常体重的心力衰竭患者相比，肥胖心力衰竭患者的预后有所改善;极端肥胖（BMI > 40 kg/m2）的预后较差。本综述的研究结果将对指导肥胖心力衰竭患者减肥具有重要意义。然而，任何关于减肥的建议都必须基于心力衰竭中肥胖悖论机制的更确凿的证据，并排除对撞机偏倚。
There is scientific consensus that obesity increases the risk of cardiovascular diseases, including heart failure. However, among persons who already have heart failure, outcomes seem to be better in obese persons as compared with lean persons: this has been termed the obesity paradox, the mechanisms of which remain unclear. This study systematically reviewed the evidence of the relationship between heart failure mortality (and survival) and weight status. Search of the PubMed/MEDLINE and EMBASE databases was done according to the PRISMA protocol. The initial search identified 9879 potentially relevant papers, out of which ten studies met the inclusion criteria. One study was a randomized clinical trial and 9 were observational cohort studies: 6 prospective and 3 retrospective studies. All studies used the BMI, WC, or TSF as measure of body fatness and NYHA Classification of Heart Failure and had single outcomes, death, as study endpoint. All studies included in review were longitudinal studies. All ten studies reported improved outcomes for obese heart failure patients as compared with their normal weight counterparts; worse prognosis was demonstrated for extreme obesity (BMI > 40 kg/m2). The findings of this review will be of significance in informing the practice of asking obese persons with heart failure to lose weight. However, any such recommendation on weight loss must be consequent upon more conclusive evidence on the mechanisms of the obesity paradox in heart failure and exclusion of collider bias.