Clinical importance of obesity versus the metabolic syndrome in cardiovascular risk in women - A report from the Women's Ischemia Syndrome Evaluation (WISE) study
Clinical importance of obesity versus the metabolic syndrome in cardiovascular risk in women - A report from the Women's Ischemia Syndrome Evaluation (WISE) study
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DOI：
10.1161/01.cir.0000115514.44135.a8
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发表时间：
2004-02-17
期刊：
影响因子：
37.8
通讯作者：
Reis, SE
中科院分区：
文献类型：
--
作者：
Kip, KE;Marroquin, OC;Reis, SE
背景——肥胖和代谢综合征经常共存。两者都与心血管疾病（CVD）有关。然而，无论是否存在代谢综合征，肥胖对心血管风险的影响仍存在争议。 方法和结果 - 根据 WISE 研究，780 名转诊接受冠状动脉造影以评估可疑心肌缺血的女性按体重指数（BMI；< 24.9 = 正常，n = 184；>= 25.0 至 = 30.0 = 肥胖，n = 327）和存在（ n = 451）或不存在（ n = 329）代谢综合征，根据糖尿病状态进一步分类。通过 BMI 和代谢状态比较显着血管造影冠状动脉疾病（CAD；≥ 50% 狭窄）的患病率和 CVD 的 3 年风险。代谢综合征和 BMI 密切相关，但只有代谢综合征与显着的 CAD 相关。同样，BMI的单位增加（正常至超重至肥胖）与3年死亡风险（调整后风险比[HR] 0.92，95% CI 0.59至1.51）或主要不良心血管事件（MACE：死亡、非致命性心肌梗死、中风、充血性心力衰竭；调整后HR 0.95，95% CI 0.71至1.27）无关，而代谢状态（正常至代谢糖尿病综合征）导致调整后的死亡风险（HR 2.01，95% CI 1.26 至 3.20）和 MACE（HR 1.88，95% CI 1.38 至 2.57）大约为 2 倍。 C 反应蛋白 (hs-CRP) 水平与代谢综合征的相关性比 BMI 更强，但与 3 年死亡风险或 MACE 的相关性并不独立。结论 - 代谢综合征而非 BMI 可以预测女性未来的心血管风险。尽管建议超重和肥胖女性减肥仍然是谨慎的，但控制正常和超重人群的所有可改变的危险因素以防止转变为代谢综合征应被视为最终目标。
Background - Obesity and the metabolic syndrome frequently coexist. Both are associated with cardiovascular disease (CVD). However, the contribution of obesity to cardiovascular risk, independent of the presence of the metabolic syndrome, remains controversial.Methods and Results - From the WISE study, 780 women referred for coronary angiography to evaluate suspected myocardial ischemia were classified by body mass index (BMI; < 24.9 = normal, n = 184; >= 25.0 to = 30.0 = obese, n = 327) and presence ( n = 451) or absence ( n = 329) of the metabolic syndrome, further classified by diabetes status. Prevalence of significant angiographic coronary artery disease ( CAD; >= 50% stenosis) and 3-year risk of CVD were compared by BMI and metabolic status. The metabolic syndrome and BMI were strongly associated, but only metabolic syndrome was associated with significant CAD. Similarly, unit increases in BMI ( normal to overweight to obese) were not associated with 3-year risk of death ( adjusted hazard ratio [HR] 0.92, 95% CI 0.59 to 1.51) or major adverse cardiovascular event ( MACE: death, nonfatal myocardial infarction, stroke, congestive heart failure; adjusted HR 0.95, 95% CI 0.71 to 1.27), whereas metabolic status ( normal to metabolic syndrome to diabetes) conferred an approximate 2-fold adjusted risk of death ( HR 2.01, 95% CI 1.26 to 3.20) and MACE ( HR 1.88, 95% CI 1.38 to 2.57). Levels of C-reactive protein (hs-CRP) were more strongly associated with metabolic syndrome than BMI but were not independently associated with 3-year risk of death or MACE.Conclusions - The metabolic syndrome but not BMI predicts future cardiovascular risk in women. Although it remains prudent to recommend weight loss in overweight and obese women, control of all modifiable risk factors in both normal and overweight persons to prevent transition to the metabolic syndrome should be considered the ultimate goal.