Clustering of Metabolic Abnormalities Among Obese Patients and Mortality After Percutaneous Coronary Intervention

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• 作者：Sameer Bashey MD^a ; Paul Muntner PhD^b ; Annapoorna S. Kini MD^a ; Ricardo Esquitin MD^a ; Louai Razzouk MD^a ; Shiny Mathewkutty MD^a ; Rachel P. Wildman PhD^c ; April P. Carson PhD^b ; Michael C. Kim MD^a ; Pedro R. Moreno MD^a ; Samin K. Sharma MD^a ; Michael E. Farkouh MD ; MSc^a ; ^d ; ^{farkom01@exchange.mssm.edu"" rel=""nofollow}
• 刊名：The American Journal of Cardiology
• 出版年：2011
• 出版时间：15 May 2011
• 年：2011
• 卷：107
• 期：10
• 页码：1415-1420
• 全文大小：534 K

文摘

Although current literature demonstrates metabolic abnormalities are associated with mortality, obese patients who tend to have more metabolic abnormalities paradoxically have lower overall mortality rates compared to their normal-weight counterparts. In this study, we examined the prevalence of metabolic abnormality clustering and its relation to mortality in obese and normal-weight patients after percutaneous coronary intervention (PCI). Patients (n = 9,673) undergoing elective PCI from October 2003 through December 2006 at a single urban hospital were categorized by body mass index (BMI) levels of 18.5 to 24.9, 25.0 to 29.9, 30.0 to 34.9, and ≥35 kg/m² and by number of metabolic abnormalities possessed (hypertension, impaired fasting glucose/diabetes, triglycerides ≥150 mg/dl, high-density lipoprotein cholesterol < 40 mg/dl, and C-reactive protein ≥2.0 mg/L). All-cause mortality was assessed through June 30, 2007. Mean age of patients was 65.9 years and 66 % were men. Prevalences of 4 or 5 metabolic abnormalities were 12 % , 18 % , 24 % , and 31 % in patients with BMI levels of 18.5 to 24.9, 25.0 to 29.9, 30 to 34.9, and ≥35 kg/m², respectively. In patients with BMI of 30.0 to 34.9 kg/m², hazard ratios (95 % confidence intervals) for mortality associated with 2, 3, and 4 to 5 metabolic abnormalities versus 0 to 1 metabolic abnormality were 1.31 (0.79 to 2.17), 1.42 (0.83 to 2.43), and 2.39 (1.24 to 4.59), respectively. Analogous hazard ratios for patients with BMI ≥35 kg/m² were 1.94 (0.90 to 4.20), 1.44 (0.63 to 3.28), and 2.17 (0.91 to 5.18). All-cause mortality rates per 1,000 person-years were 55.5, 33.7, 28.3, and 33.8 in patients with BMI levels of 18.5 to 24.9, 25 to 29.9, 30 to 34.9, and ≥35 kg/m², respectively. In conclusion, BMI levels of 25.0 to 29.9 and 30 to 34.9 kg/m² were associated with lower all-cause mortality after PCI. However, an increased number of metabolic abnormalities translated into increased all-cause mortality.