超越肥胖:代谢状况是进行侵入性冠状动脉血管造影的患者心血管结果的关键驱动因素
Eva Steinacher1, Andreas Hammer1, Ulrike Baumer1
1Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
European heart journal. Quality of care & clinical outcomes
|April 29, 2025
概括
代谢健康,而不是肥胖,对于预防慢性冠状动脉综合征患者心血管不良事件至关重要. 优先考虑代谢概况而不是BMI,可以改善风险评估和个性化治疗策略.
科学领域:
- 心脏病学 心脏病学
- 代谢健康 代谢健康
- 肥胖问题研究研究
背景情况:
- 代谢障碍和肥胖是冠状动脉疾病 (CAD) 和主要不良心血管事件 (MACE) 的已知危险因素.
- 肥胖作为新陈代谢健康个体,特别是患有CAD的个体心血管风险修饰者的独立作用需要进一步调查.
研究的目的:
- 在接受侵入性冠状动脉血管学 (ICA) 的患者中研究与不同代谢表型相关的风险概况.
- 确定是否代谢健康或肥胖是慢性冠状动脉综合征 (CCS) 患者心血管结果的更强有力的预测因素.
主要方法:
- 一组12760名被评估为CCS的患者被分为四种代谢表型:代谢健康的非肥胖者 (MHN),代谢健康的肥胖者 (MHO),代谢不健康的非肥胖者 (MUN) 和代谢不健康的肥胖者 (MUO).
- 根据年龄,性别和功能障碍进行调整的考克斯回归模型被用于评估代谢表型与MACE,全因死亡率和再血管化等结果之间的关联.
主要成果:
- 该研究发现,代谢表型显著影响了MACE,死亡率和再血管化的风险.
- 代谢性疾病是不良事件的强有力的预测因素,而仅仅肥胖并不是一个显著的独立预测因素 (例如,MHO与MHN: adj. HR 0.947; MUO 与 MUN 相比: 调整. HR 0.974) 的情况.
- 有趣的是,随着身体质量指数 (BMI) 的增加,代谢健康的个体表现出较低的事件率,这表明存在肥胖悖论.
结论:
- 代谢健康是预防CCS中不良心血管事件的更重要的预测因素,而不是肥胖.
- 心血管风险评估应强调代谢健康状况,而不是BMI.
- 将新陈代谢分析纳入常规临床评估可以提高预防力度,并为CCS患者个性化治疗策略.
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