心力衰竭中的肥胖悖论重新审视:病因学作为效果修饰剂
Liyan Huang1, Xuemei Zhao1, Lin Liang1
1Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China.
The American journal of cardiology
|September 28, 2023
概括
在心力衰竭 (HF) 中,体重指数的预后值因原因而异. 患有非缺血性,非扩张性心肌病 (HF) 的超重患者的生存率更好,但这种益处在缺血性或DCM HF中没有见到.
科学领域:
- 心脏病学 心脏病学
- 临床研究 临床研究
- 公共卫生 公共卫生
背景情况:
- 体重指数 (BMI) 和心力衰竭 (HF) 的结果之间的关系是复杂的,并可能因HF病因而异.
- 之前的研究表明HF中存在"肥胖悖论",但这需要在不同的病因子组进行进一步的研究.
研究的目的:
- 为了研究BMI对住院患者不同心力衰竭病因的存活率的差异影响.
- 为了确定超重/肥胖是否在特定的HF病因群体中赋予生存益处.
主要方法:
- 对3836名住院HF患者 (2006年12月 - 2017年12月) 的回顾性分析.
- 将HF病因分为缺血性,扩张性心肌病 (DCM) 和非缺血性-非DCM.
- 多变量Cox比例危险模型和受限立方线,以评估BMI对死亡率的影响.
主要成果:
- 超重的生存益处仅在非缺血性非DCM HF (aHR 0.69,95% CI 0.52-0.91) 的患者中观察到,BMI 28.18 kg/m2的死亡率最低.
- 在患有缺血性HF (aHR1.07,95%CI 0.84-1.36) 或DCM HF (aHR 0.97,95%CI 0.74-1.28) 的患者中,没有发现超重对生存有显著的益处.
- 未经调整的数据最初表明,在所有HF病因方面存在着与脂肪相关的生存悖论.
结论:
- 超重状态不会改善缺血性或DCM病因的心力衰竭患者的存活率.
- 超重的预后益处仅在非缺血性非DCM HF 亚组中保持.
- 需要进一步的研究来探索特定HF病因学中的病理生理机制和体重管理的潜在益处.
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