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冠心病患者的体重起伏和结局
Body-Weight Fluctuations and Outcomes in Coronary Disease


Sripal Bangalore ... 心脑血管疾病 • 2017.04.06
相关阅读
• 体重起伏何时不利于健康

摘要


背景

对没有心血管疾病的患者,体重起伏是患者死亡和冠脉事件的危险因素。但对冠心病患者,尚不清楚体重变异是否会影响结局。

 

方法

治疗达新标(Treating to New Targets)试验是一项评估阿托伐他汀降低低密度脂蛋白胆固醇的疗效和安全性的研究,我们测定了患者体重从基线到随访访视发生的个体自身起伏,并且做了事后分析。主要结局是任意冠脉事件,它是冠心病导致的死亡、非致死性心肌梗死、心脏停搏复苏、血运重建或心绞痛构成的复合结局。次要结局是任何心血管事件(任意冠脉事件、脑血管事件、外周血管疾病或心力衰竭构成的复合结局)、死亡、心肌梗死或卒中。

 

结果

我们研究了9,509名参与者,校正危险因素、基线血脂水平、平均体重和体重变化后,发现每增加1个SD的体重变异(依照平均连续变异进行测定,并作为时间依赖性协变量),会伴有任意冠脉事件(2,091起事件,风险比是1.04,95%置信区间[CI],1.01~1.07,P=0.01)、任意心血管事件(2,727起事件,风险比1.04,95% CI,1.02~1.07,P<0.001)及死亡(487起事件,风险比1.09,95% CI,1.07~1.12,P<0.001)的发生危险增加。在校正模型中,与体重变异位于最低五分位的患者相比,体重变异位于最高五分位的患者的冠脉事件发生危险增加64%,心血管事件发生危险增加85%,死亡危险增加124%,心肌梗死发生危险增加117%,卒中发生危险增加136%。

 

结论

对冠心病患者而言,体重起伏独立于传统心血管危险因素,伴有较高的死亡率和较高的心血管事件发生率(由辉瑞[Pfizer]公司资助,在ClinicalTrials.gov注册号为NCT00327691)。





作者信息

Sripal Bangalore, M.D., M.H.A., Rana Fayyad, Ph.D., Rachel Laskey, Ph.D., David A. DeMicco, Pharm.D., Franz H. Messerli, M.D., and David D. Waters, M.D.
From the New York University School of Medicine (S.B.), Pfizer (R.F., R.L., D.A.D.), and the Mount Sinai Icahn School of Medicine (F.H.M.) — all in New York; University Hospital, Bern, Switzerland (F.H.M.); Jagiellonian University, Krakow, Poland (F.H.M.); and San Francisco General Hospital, San Francisco (D.D.W.). Address reprint requests to Dr. Bangalore at the Cardiac Catheterization Laboratory, New York University School of Medicine, Leon H. Charney Division of Cardiology, New York, NY 10016, or at sripalbangalore@gmail.com.

 

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