背景:肥胖是血脂异常发展的重要危险因素,糖尿病,高血压,冠状动脉疾病,心室功能障碍,充血性心力衰竭(HF),中风,和心律失常.
目的:这项荟萃分析对体重指数(BMI)与急性冠脉综合征预后之间仍有争议的相关性进行了综合评估。
方法:系统地搜索PubMed/ScienceDirect数据库中具有基线参数的研究,主要(HF,心源性休克,心脏骤停,再梗死,中风,死亡,住院总并发症)和次要结局(再梗死,中风,死亡,总主要不良心血管事件[MACE])与BMI相关,严格分为四组(体重不足[<18.5kg/m2],正常体重[18.5-24.9kg/m2],超重[25.0-29.9kg/m2],和肥胖[≥30.0kg/m2],分为轻度肥胖[30.0-34.9kg/m2]和重度肥胖[≥35.0kg/m2])。
结果:我们纳入了24项研究,585,919名参与者(男性占55.5%),66.8岁。体重过轻与高血压呈负相关,高脂血症和糖尿病,与主要结果呈正相关{HF(比值比[OR]=1.37,置信区间[CI][1.15-1.63]),心源性休克(OR=1.43,CI[1.04-1.98]),行程(OR=1.21,CI[1.05-1.40]),总死亡(OR=1.64,CI[1.20-2.26]),总住院并发症(OR=1.39,CI[1.24-1.56])}和34个月随访期间的次要结局{心血管/总死亡(OR=3.78,CI[1.69-8.49]/OR=2.82,CI[2.29-3.49]),分别,总MACE(OR=2.77,CI[2.30-3.34])}(所有p<0.05)。肥胖与高血压呈正相关,高脂血症,糖尿病和吸烟,和阴性的主要结局{再梗死(OR=0.83,CI[0.76-0.91]),中风(OR=0.67,CI[0.54-0.85]),总死亡(OR=0.55,CI[0.49-0.63]),住院总并发症(OR=0.81,CI[0.70-0.93])}和次要结局{心血管/总体死亡(OR=0.77,CI[0.66-0.88]/OR=0.62,CI[0.53-0.72]),分别,总MACE(OR=0.63,CI[0.60-0.77])}(所有p<0.05)。这种与几种主要结局呈负相关(心源性休克,整体死亡,住院总并发症)和次要结局(心血管/总体死亡,总MACE)在轻度肥胖患者中更为明显(p<0.05)。这些结果给出了具有双峰模式(略呈U形)的“肥胖悖论”。
结论:肥胖与传统心血管危险因素呈正相关,与主要和次要结局呈负相关,这证实了整体“肥胖悖论”的持续存在。\"
BACKGROUND: Obesity is an important risk factor for the development of dyslipidemia, diabetes mellitus, hypertension, coronary artery disease, ventricular dysfunction, congestive heart failure (HF), stroke, and cardiac arrhythmias.
OBJECTIVE: This meta-analysis brings comprehensive evaluation about still controversial association between the body mass index (BMI) and the outcomes of acute coronary syndrome.
METHODS: PubMed/ScienceDirect databases were systematically searched for studies with baseline parameters, primary (HF, cardiogenic shock, cardiac arrest, reinfarction, stroke, death, total in-hospital complications) and secondary outcomes (reinfarction, stroke, death, total major adverse cardiovascular events [MACE]) in relation to BMI strictly classified into four groups (underweight [<18.5 kg/m2], normal weight [18.5-24.9 kg/m2], overweight [25.0-29.9 kg/m2], and obese [≥30.0 kg/m2], grouped into mildly obese [30.0-34.9 kg/m2] and severely obese [≥35.0 kg/m2]).
RESULTS: We included 24 studies, with 585,919 participants (55.5% males), aged 66.8 years. Underweight was negatively associated with hypertension, hyperlipidemia and diabetes, and positively with primary outcomes {HF (odds ratio [OR] = 1.37, confidence interval [CI] [1.15-1.63]), cardiogenic shock (OR = 1.43, CI [1.04-1.98]), stroke (OR = 1.21, CI [1.05-1.40]), overall death (OR = 1.64, CI [1.20-2.26]), total in-hospital complications (OR = 1.39, CI [1.24-1.56])} and secondary outcomes during 34-month follow-up {cardiovascular/overall death (OR = 3.78, CI [1.69-8.49]/OR = 2.82, CI [2.29-3.49]), respectively, total MACE (OR = 2.77, CI [2.30-3.34])} (for all p < 0.05). Obesity had positive association with hypertension, hyperlipidemia, diabetes and smoking, and negative with primary outcomes {reinfarction (OR = 0.83, CI [0.76-0.91]), stroke (OR = 0.67, CI [0.54-0.85]), overall death (OR = 0.55, CI [0.49-0.63]), total in-hospital complications (OR = 0.81, CI [0.70-0.93])} and secondary outcomes {cardiovascular/overall death (OR = 0.77, CI [0.66-0.88]/OR = 0.62, CI [0.53-0.72]), respectively, total MACE (OR = 0.63, CI [0.60-0.77])} (for all p < 0.05). This negative association with several primary outcomes (cardiogenic shock, overall death, total in-hospital complications) and secondary outcomes (cardiovascular/overall death, total MACE) was more pronounced in mild obesity (p < 0.05). These results give an \"obesity paradox\" with a bimodal pattern (slightly U-shaped).
CONCLUSIONS: Obesity is positively associated with traditional cardiovascular risk factors and negatively with primary and secondary outcomes, which confirms the persistence of overall \"obesity paradox.\"