Obesity and the risk of heart failure
Obesity and the risk of heart failure
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DOI：
10.1056/nejmoa020245
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发表时间：
2002-08-01
影响因子：
158.5
通讯作者：
Vasan, RS
中科院分区：
文献类型：
--
作者：
Kenchaiah, S;Evans, JC;Vasan, RS
极端肥胖被认为是心力衰竭的危险因素。目前还不清楚超重和轻度肥胖是否也会带来风险。方法我们调查了Framingham心脏研究中5881名参与者（平均年龄55岁，54%女性）的身体质量指数（体重以公斤为单位除以身高以米为单位的平方）与心力衰竭发生率之间的关系。使用Cox比例风险模型，将身体质量指数作为连续变量和分类变量进行评估（正常，18.5至24.9；超重，25.0至29.9；肥胖，30.0或以上）。结果在随访期间（平均14年），496名受试者（258名女性和238名男性）出现心力衰竭。在对已确定的危险因素进行调整后，体重指数每增加1，男性患心力衰竭的风险增加5%，女性增加7%。与身体质量指数正常的受试者相比，肥胖受试者患心力衰竭的风险增加了一倍。对于女性，风险比为2.12(95%置信区间，1.51至2.97)；对于男性，风险比为1.90（95%置信区间，1.30至2.79）。在身体质量指数的不同类别中观察到心力衰竭的风险逐级增加。每增加一个类别的风险比，女性为1.46(95%可信区间，1.23至1.72)，男性为1.37（95%可信区间，1.13至1.67）。在我们以社区为基础的大型样本中，体重指数的增加与心力衰竭风险的增加有关。鉴于肥胖在美国的高患病率，促进最佳体重的策略可能会减少心力衰竭的人口负担。
Background Extreme obesity is recognized to be a risk factor for heart failure. It is unclear whether overweight and lesser degrees of obesity also pose a risk.Methods We investigated the relation between the body-mass index (the weight in kilograms divided by the square of the height in meters) and the incidence of heart failure among 5881 participants in the Framingham Heart Study (mean age, 55 years; 54 percent women). With the use of Cox proportional-hazards models, the body-mass index was evaluated both as a continuous variable and as a categorical variable (normal, 18.5 to 24.9; overweight, 25.0 to 29.9; and obese, 30.0 or more).Results During follow-up (mean, 14 years), heart failure developed in 496 subjects (258 women and 238 men). After adjustment for established risk factors, there was an increase in the risk of heart failure of 5 percent for men and 7 percent for women for each increment of 1 in body-mass index. As compared with subjects with a normal body-mass index, obese subjects had a doubling of the risk of heart failure. For women, the hazard ratio was 2.12 (95 percent confidence interval, 1.51 to 2.97); for men, the hazard ratio was 1.90 (95 percent confidence interval, 1.30 to 2.79). A graded increase in the risk of heart failure was observed across categories of body-mass index. The hazard ratios per increase in category were 1.46 in women (95 percent confidence interval, 1.23 to 1.72) and 1.37 in men (95 percent confidence interval, 1.13 to 1.67).Conclusions In our large, community-based sample, increased body-mass index was associated with an increased risk of heart failure. Given the high prevalence of obesity in the United States, strategies to promote optimal body weight may reduce the population burden of heart failure.