■先前的研究几乎没有评估体重指数(BMI)或腰围的变异性与临床不良事件的关系,并且调查体重循环是否对射血分数保留的心力衰竭患者的预后有影响(HFpEF)。
■这项研究是对TOPCAT的事后分析。评估了三个结果:主要终点,心血管疾病(CVD)死亡,心力衰竭住院。其中,心血管疾病死亡和住院是心力衰竭的结果。Kaplan-Meier曲线用于描述结果的累积风险,并使用对数秩检验进行测试。Cox比例风险回归模型用于计算结果的风险比(HRs)和95CI。我们还进行了亚组分析,并对几个亚组进行了比较。
■共纳入3,146例患者。在Kaplan-Meier曲线中,BMI和腰围的变异系数按四分位数分组,Q4组的累积风险最高(log-rankP<0.001)。在BMI变异系数和结果中,主要终点BMI变异系数Q4组的HR为2.35(95CI:1.82,3.03),2.40(95CI:1.69,3.40)死亡,与Q1组相比,模型3(完全校正模型)的HF住院率和2.33(95CI:1.68,3.22)。在腰围变异系数和结果方面,Q4组的主要终点风险增加[HR:2.39(95CI:1.84,3.12)],心血管疾病死亡[HR:3.29(95CI:2.28,4.77)],与Q1组相比,模型3(完全校正模型)中的HF住院率[HR:1.98(95CI1.43,2.75)]。在亚组分析中,糖尿病亚组存在显著的交互作用(交互作用P=0.0234).
■体重循环对HFpEF患者的预后有负面影响。糖尿病合并症的存在削弱了腰围变异性与临床不良事件之间的关系。
Previous studies hardly evaluated the association of variability of body mass index (BMI) or waist circumference with clinical adverse events and investigated whether weight cycling had an effect on the prognosis of patients with heart failure with preserved ejection fraction (HFpEF).
This study was a post-hoc analysis of TOPCAT. Three outcomes were evaluated: the primary endpoint, cardiovascular disease (CVD) death, and heart failure hospitalization. Among them, CVD death and hospitalization were outcomes of heart failure. Kaplan-Meier curves were used to describe the cumulative risk of outcome and were tested using the log-rank test. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95%CIs for outcomes. We also performed a subgroup analysis, and several subgroups were compared.
A total of 3,146 patients were included. In the Kaplan-Meier curves, the coefficients of variation of both BMI and waist circumference were grouped according to quartiles, with the Q4 group having the highest cumulative risk (log-rank P < 0.001). In the coefficient of BMI variation and the outcomes, the HRs for group Q4 of coefficient of variation of BMI were 2.35 (95%CI: 1.82, 3.03) for the primary endpoint, 2.40 (95%CI: 1.69, 3.40) for death, and 2.33 (95%CI: 1.68, 3.22) for HF hospitalization in model 3 (fully adjusted model) compared with group Q1. In the coefficient of waist circumference variation and the outcomes, group Q4 had increased hazard of the primary endpoint [HR: 2.39 (95%CI: 1.84, 3.12)], CVD death [HR: 3.29 (95%CI: 2.28, 4.77)], and HF hospitalization [HR: 1.98 (95%CI 1.43, 2.75)] in model 3 (fully adjusted model) compared with group Q1. In the subgroup analysis, there was a significant interaction in the diabetes mellitus subgroup (P for interaction = 0.0234).
Weight cycling had a negative effect on the prognosis of patients with HFpEF. The presence of comorbid diabetes weakened the relationship between waist circumference variability and clinical adverse events.