心力衰竭患者的体重指数和生存率
Nicholas R Jones1, José M Ordóñez-Mena2,3, Andrea K Roalfe2
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK nicholas.jones2@phc.ox.ac.uk.
Heart (British Cardiac Society)
|June 8, 2023
概括
心力衰竭中的肥胖悖论表明,更高的BMI可能会改善结果. 这项研究发现,患有高血压的超重和肥胖个体的死亡风险较低,而体重不足的患者面临风险增加.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 流行病学 流行病学
背景情况:
- "肥胖悖论"将更高的体重指数 (BMI) 与心力衰竭 (HF) 的更好的结果联系在一起.
- 关于BMI的社区 HF 种群的长期存活的证据有限.
- 这项研究调查了BMI与HF初级保健患者的长期死亡率之间的关联.
研究的目的:
- 检查心力衰竭患者的大型初级保健队列中预诊断BMI和全因死亡率之间的关系.
- 在HF患者中评估不同BMI类别 (体重不足,健康体重,超重,肥胖等级I-III) 的长期生存趋势.
主要方法:
- 利用临床实践研究数据链接 (CPRD) 对45岁以上 (2000-2017年) 发生心力衰竭 (HF) 患者的队列进行了研究.
- 采用卡普兰-梅尔曲线,考克斯回归和处罚斜线方法来分析预诊断BMI与全因死亡率的关联.
- 按世界卫生组织 (WHO) 标准分类的BMI.
主要成果:
- 分析了超过47,000名高压患者,超过52%的患者在随访期间经历死亡.
- 与健康体重相比,超重 (HR 0.78) 和肥胖类I (HR 0.76) 和II (HR 0.76) 与死亡风险降低有关.
- 体重不足的人死亡风险明显增加 (HR 1.59),特别是男性.
- 与超重个体相比,III类肥胖症显示所有原因死亡风险增加 (HR 1.23).
结论:
- 在初级保健HF患者的BMI和长期全因死亡率之间存在U形关系.
- 个性化体重管理策略可能是必要的,以优化心力衰竭的结果.
- 体重不足的心力衰竭患者是高风险群体,需要特别注意和认可.
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