Obesity and cardiovascular events in patients with established coronary disease
Obesity and cardiovascular events in patients with established coronary disease
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DOI：
10.1093/eurheartj/ehl022
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发表时间：
2006-06-01
影响因子：
39.3
通讯作者：
Braunwald, Eugene
中科院分区：
文献类型：
--
作者：
Domanski, Michael J.;Jablonski, Kathleen A.;Braunwald, Eugene
目的探讨已确诊冠心病（CAD）患者肥胖与主要冠状动脉不良事件（MACE）的关系。方法和结果血管紧张素转换酶抑制剂预防事件（PEACE）试验将8290例稳定型CAD和左室射血分数（EF） (LVEF) >= 0.40的患者随机分配给trandolapril或安慰剂，随访时间中位数为4.8年。在基线时非糖尿病的PEACE患者（5693名男性和1171名女性）中，我们使用比例风险模型进行事后分析，以检查肥胖(定义为体重指数（BMI) >= 30 kg/m(2)）是否是MACE复合终点（定义为心血管死亡、非致死性心肌梗死、冠状动脉血运重建或中风）的独立危险因素。这项分析是分别对男性和女性进行的。男性和女性的基线肥胖患病率分别为28.5%和28.9%。在调整了显著混杂因素后，肥胖与男性的MACE相关[危险比(HR) = 1.28, 95% CI 1.13-1.46, P < 0.01]，但与女性无关（HR = 0.96, 95% CI 0.70-1.31, P = 0.77）。进一步的BMI分类显示，男性BMI与MACE呈j型相关，而女性则无关联。结论：在存在冠心病的情况下，肥胖与男性发生MACE的风险相关，但在女性中没有相关的证据。这一发现需要进一步评价。
Aims To explore the association between obesity and major adverse coronary events (MACE) in patients with established coronary artery disease (CAD).Methods and results The Prevention of Events with Angiotensin Converting Enzyme-Inhibition (PEACE) Trial randomized 8290 patients with stable CAD and left ventricular (LV) ejection fraction (EF) (LVEF) >= 0.40 to trandolapril or placebo and followed them for a median of 4.8 years. In PEACE patients who were non-diabetic at baseline (5693 men and 1171 women), we used proportional hazards models to conduct a post hoc analysis to examine whether obesity, defined as a body mass index (BMI) >= 30 kg/m(2), is an independent risk factor for the composite endpoint of MACE, defined as cardiovascular death, non-fatal myocardial infarction, coronary revascularization, or stroke. The analysis was conducted separately for men and women. The baseline prevalence of obesity was 28.5% in men and 28.9% in women. After adjusting for significant confounders, obesity was associated with MACE in men [hazard ratio (HR) = 1.28, 95% CI 1.13-1.46, P < 0.01], but not in women (HR = 0.96, 95% CI 0.70-1.31, P = 0.77). Further categorization of BMI showed a J-shaped association between BMI and MACE in the men, and no association in the women.Conclusion In the presence of established CAD, obesity is associated with risk for MACE in men, but there is no support of an association in women. This finding requires further evaluation.