Abstract：
BACKGROUND: Numerous studies have indicated that increased obesity in patients with established peripheral artery disease (PAD) is inversely associated with disease prognosis, a phenomenon coined as the \"obesity paradox\". A major cause of criticism in studies investigating the obesity paradox is the use of body mass index (BMI) as a surrogate marker in defining and quantifying the degree or severity of obesity. We conducted a retrospective review to verify whether the obesity paradox persists in patients with PAD when using body surface area (BSA) as an alternative anthropometric measure.
METHODS: Patients undergoing surgery (open or endovascular) for PAD between January 2009 and March 2020 were identified from the Vascular Quality Initiative (VQI) national database. The association between BSA or BMI and risk of postoperative complications was evaluated using logistic regression and restricted cubic spline analysis, both of which were adjusted for demographic and comorbid risk predictors. When analyzing BSA and BMI as categorical variables, patients were grouped according to BSA quintiles and the World Health Organization (WHO) BMI categories.
RESULTS: A total of 130,428 patients were included based on our eligibility criteria, of which 85,394 (65.5%) were men. Patients were typically hypertensive (87.8%), diabetic (50.4%), and overweight (63.0% over 25 kg/m2). Patients with a high BMI or BSA typically presented at a younger age and with greater preoperative administration of drugs (statin, angiotensin converting enzyme inhibitor, anticoagulant, and beta blocker). Our results indicate that BSA and BMI are inversely associated with postoperative risk of all-cause morbidity, mortality, and cardiac complications. This finding was displayed when analyzing BMI or BSA as a continuous variable or when indexing patients into BMI or BSA groups.
CONCLUSIONS: Our data suggests that the obesity paradox persists in patients with PAD when using either BMI or BSA as anthropometric measures. Future studies with a prospective design and utilizing newer anthropometric indices should be conducted to fully verify the presence of this phenomenon.
METHODS: Patients undergoing surgery (open or endovascular) for PAD between January 2009 and March 2020 were identified from the Vascular Quality Initiative (VQI) national database. The association between BSA or BMI and risk of postoperative complications was evaluated using logistic regression and restricted cubic spline analysis, both of which were adjusted for demographic and comorbid risk predictors. When analyzing BSA and BMI as categorical variables, patients were grouped according to BSA quintiles and the World Health Organization (WHO) BMI categories.
RESULTS: A total of 130,428 patients were included based on our eligibility criteria, of which 85,394 (65.5%) were men. Patients were typically hypertensive (87.8%), diabetic (50.4%), and overweight (63.0% over 25 kg/m2). Patients with a high BMI or BSA typically presented at a younger age and with greater preoperative administration of drugs (statin, angiotensin converting enzyme inhibitor, anticoagulant, and beta blocker). Our results indicate that BSA and BMI are inversely associated with postoperative risk of all-cause morbidity, mortality, and cardiac complications. This finding was displayed when analyzing BMI or BSA as a continuous variable or when indexing patients into BMI or BSA groups.
CONCLUSIONS: Our data suggests that the obesity paradox persists in patients with PAD when using either BMI or BSA as anthropometric measures. Future studies with a prospective design and utilizing newer anthropometric indices should be conducted to fully verify the presence of this phenomenon.
摘要：
目的：大量研究表明，患有外周动脉疾病（PAD）的患者肥胖增加与疾病预后呈负相关。一种被称为“肥胖悖论”的现象。在调查肥胖悖论的研究中，批评的主要原因是使用体重指数（BMI）作为定义和量化肥胖程度或严重程度的替代标记。我们进行了回顾性审查，以验证使用体表面积（BSA）作为替代人体测量指标时，肥胖悖论是否在PAD患者中持续存在。
方法：从血管质量倡议（VQI）国家数据库中确定了2009年1月至2020年3月期间接受PAD手术（开放或血管内）的患者。使用logistic回归和限制性三次样条分析评估BSA/BMI与术后并发症风险之间的关系，两者都根据人口统计学和合并症风险预测因子进行了调整。当将BSA和BMI作为分类变量进行分析时，根据BSA五分位数和世界卫生组织(WHO)BMI类别对患者进行分组.
结果：根据我们的资格标准，共纳入130,428例患者。其中85,394（65.5％）是男性。患者通常为高血压（87.8%），糖尿病（50.4%），和超重（超过25公斤/平方米的63.0%）。BMI或BSA高的患者通常在较年轻的年龄和较多的术前给药（他汀类药物，ACE抑制剂，抗凝剂,和β受体阻滞剂)。我们的结果表明，BSA和BMI与全因发病率的术后风险呈负相关。死亡率,和心脏并发症。这一发现是在分析BMI/BSA作为连续变量时显示的，或将患者分为BMI/BSA组。
结论：我们的数据表明，当使用BMI或BSA作为人体测量指标时，PAD患者的肥胖悖论仍然存在。应进行具有前瞻性设计并利用较新的人体测量指标的未来研究，以充分验证这种现象的存在。
方法：从血管质量倡议（VQI）国家数据库中确定了2009年1月至2020年3月期间接受PAD手术（开放或血管内）的患者。使用logistic回归和限制性三次样条分析评估BSA/BMI与术后并发症风险之间的关系，两者都根据人口统计学和合并症风险预测因子进行了调整。当将BSA和BMI作为分类变量进行分析时，根据BSA五分位数和世界卫生组织(WHO)BMI类别对患者进行分组.
结果：根据我们的资格标准，共纳入130,428例患者。其中85,394（65.5％）是男性。患者通常为高血压（87.8%），糖尿病（50.4%），和超重（超过25公斤/平方米的63.0%）。BMI或BSA高的患者通常在较年轻的年龄和较多的术前给药（他汀类药物，ACE抑制剂，抗凝剂,和β受体阻滞剂)。我们的结果表明，BSA和BMI与全因发病率的术后风险呈负相关。死亡率,和心脏并发症。这一发现是在分析BMI/BSA作为连续变量时显示的，或将患者分为BMI/BSA组。
结论：我们的数据表明，当使用BMI或BSA作为人体测量指标时，PAD患者的肥胖悖论仍然存在。应进行具有前瞻性设计并利用较新的人体测量指标的未来研究，以充分验证这种现象的存在。
