Prospective study of BMI and the risk of pulmonary embolism in women.
Prospective study of BMI and the risk of pulmonary embolism in women.
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DOI：
10.1038/oby.2009.92
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发表时间：
2009-11
期刊：
影响因子：
6.9
通讯作者：
Camargo, Carlos A.
中科院分区：
文献类型：
--
作者：
Kabrhel, Christopher;Varraso, Raphaelle;Goldhaber, Samuel Z.;Rimm, Eric B.;Camargo, Carlos A.
肺栓塞（PE）是常见的，并与显著的发病率和死亡率相关。肥胖和体育之间的联系已经提出，但这种联系的性质尚未得到很好的界定。我们在护士健康研究（1984-2002）中对87,226名女性进行了前瞻性队列研究，以确定BMI与PE事件风险之间的关系。主要暴露是BMI（<22.5, 22.5 - 24.9, 25.0-27.4, 27.5-29.9, 30.0-34.9和≥35.0 kg/m2）。主要结局是特发性PE（医疗记录证实的PE病例与既往手术、创伤或恶性肿瘤无关）。非特发性PE的二次分析也进行。多变量Cox比例风险模型控制了年龄、体力活动、热量摄入、吸烟、年龄、种族、配偶受教育程度、性别、更年期、非阿司匹林非甾体抗炎药、华法林、多种维生素补充剂、高血压、冠心病和风湿病。特发性PE 157例，非特发性PE 338例。BMI、特发性PE风险(相对危险度（RR) = 1.08(95%可信区间（CI）， 1.06-1.10) /每增加1 kg/m2， P < 0.001）与非特发性PE （RR = 1.08 (95% CI, 1.07-1.10), P < 0.001）之间存在显著正相关。这种关联是线性的，即使BMI适度增加（22.5-25 kg/m2）也很明显。在BMI≥35 kg/m2的受试者中，风险增加了近6倍，并且存在于多个亚组中。BMI的增加与女性PE的发展有很强的线性关系。临床医生在评估患者PE风险时应考虑BMI。
Pulmonary embolism (PE) is common and associated with significant morbidity and mortality. An association between obesity and PE has been suggested, but the nature of the association has not been well defined. We performed a prospective cohort study of 87,226 women in the Nurses’ Health Study (1984–2002) to define the association between BMI and the risk of incident PE. Primary exposure was BMI (<22.5, 22.5–24.9, 25.0–27.4, 27.5–29.9, 30.0–34.9, and ≥35.0 kg/m2). Primary outcome was idiopathic PE (medical record confirmed cases of PE not associated with prior surgery, trauma, or malignancy). Secondary analysis of nonidiopathic PE was also performed. Multivariable Cox proportional hazards models were controlled for age, physical activity, caloric intake, smoking, pack-years, race, spouse’s educational attainment, parity, menopause, nonaspirin nonsteroidal anti-inflammatory drugs, warfarin, multivitamin supplements, hypertension, coronary heart disease, and rheumatological disease. There were 157 incident idiopathic PE and 338 nonidiopathic PE. There was a strong positive association between BMI, the risk of idiopathic PE (relative risk (RR) = 1.08 (95% confidence interval (CI), 1.06–1.10) per 1 kg/m2 increase in BMI, P < 0.001) and nonidiopathic PE (RR = 1.08 (95% CI, 1.07–1.10), P < 0.001). The association was linear, and apparent even with modest increases in BMI (22.5–25 kg/m2). The risk increased nearly sixfold among subjects with BMI ≥35 kg/m2, and was present in multiple subgroups. Increasing BMI has a strong, linear association with the development of PE in women. Clinicians should consider BMI when assessing the risk of PE in their patients.
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