体重指数对 LDL-C 低于 55 mg/dL 和 LDL-C 低于 70 mg/dL 患者重复冠状动脉血运重建率的影响：韩国一项为期 42 个月的队列研究。

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular diagnosis and therapy Pub Date : 2024-08-31 Epub Date: 2024-07-31 DOI:10.21037/cdt-24-27

Chang-Yeon Kim, Jae Yong Lee, Hae Won Jung

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引用次数: 0

摘要

背景：以前的研究显示，在接受经皮冠状动脉介入治疗（PCI）的患者中，体重指数（BMI）与重复冠状动脉血运重建率之间存在线性关系。然而，在符合韩国血脂异常指南新旧目标低密度脂蛋白胆固醇（LDL-C）水平的韩国患者中，这种关系尚未得到证实。因此，我们开展了这项研究，以了解 BMI 对低密度脂蛋白胆固醇患者重复冠状动脉血运重建率的影响：在韩国大邱天主教医疗中心进行了为期 42 个月的队列研究。我们纳入了 429 名低密度脂蛋白胆固醇（LDL-C）患者（2 ≤ BMI < 23 kg/m2），以及低密度脂蛋白胆固醇患者中的肥胖前组和肥胖组（23 kg/m2 ≤ BMI）：在随访期间，低密度脂蛋白胆固醇组与76.2%的无冠状动脉血运重建生存率（P=0.32）之间无明显差异。在体重正常的患者中，LDL-C 组与 77.1%，P=0.05）。正常体重组与肥胖前和肥胖组患者的无血管再通存活率无明显差异，LDL-C组为75.7%，P=0.67）。然而，在低密度脂蛋白胆固醇患者中，正常体重组与肥胖前和肥胖组相比，无血管再通存活率明显更高（低密度脂蛋白胆固醇患者：74.3%；肥胖前和肥胖组：74.3%；P=0.03）。正常体重与 LDL-C 结论：在韩国的 PCI 患者中，体重正常且 LDL-C 水平低于 70 毫克/分升但高于 55 毫克/分升的患者应接受更强化的治疗，将 LDL-C 降至 55 毫克/分升以下。对于成功将低密度脂蛋白胆固醇降至 55 毫克/分升以下的肥胖患者，似乎应尝试将体重降至正常体重水平。

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Impact of body mass index on repeat coronary revascularization rates in patients with LDL-C below 55 mg/dL and LDL-C below 70 mg/dL: a 42-month cohort study in Korea.

Background: Previous studies revealed a linear relationship between body mass index (BMI) and repeat coronary revascularization rate in patients who underwent percutaneous coronary intervention (PCI). However, this relationship has not been demonstrated in Korean patients who meet old and new target low-density lipoprotein cholesterol (LDL-C) levels of Korean dyslipidemia guidelines. Therefore, we conducted this study to find out the effect of BMI on repeat coronary revascularization rate in patients with LDL-C <55 mg/dL and patients with LDL-C <70 mg/dL.

Methods: This cohort study was followed for 42 months in Daegu Catholic Medical Center, Korea. We included 429 patients with LDL-C <70 mg/dL 1 year after PCI. We compared repeat revascularization rates using Kaplan-Meier survival curves between the normal weight group (18.5 kg/m² ≤ BMI < 23 kg/m²) and the pre-obesity and obesity group (23 kg/m² ≤ BMI) in patients with LDL-C <55 mg/dL and patients with LDL-C <70 mg/dL.

Results: During a follow-up period, there was no significant difference in repeat coronary revascularization-free survival between a group with LDL-C <55 mg/dL and a group with LDL-C <70 mg/dL (79.6% vs. 76.2%, P=0.32). In normal weight patients, LDL-C <55 mg/dL group showed higher repeat coronary revascularization-free survival than LDL-C <70 mg/dL group (89.3% vs. 77.1%, P=0.05). There was no significant difference in repeat revascularization-free survival between the normal weight group and the pre-obesity and obesity group in patients with LDL-C <70 mg/dL (77.1% vs. 75.7%, P=0.67). However, the normal weight group showed significantly higher repeat revascularization-free survival compared to the pre-obesity and obesity group in patients with LDL-C <55 mg/dL (89.3% vs. 74.3%, P=0.03). Normal body weight and LDL-C <55 mg/dL [hazard ratio (HR): 0.421, 95% confidence interval (CI): 0.193-0.916, P=0.02] was the only independent predictor for repeat revascularization.

Conclusions: In Korean PCI patients with normal body weight whose LDL-C level is less than 70 mg/dL, but more than 55 mg/dL, should be treated with more intensive therapy to lower LDL-C to less than 55 mg/dL. For obese patients who have succeeded in reducing LDL-C below 55 mg/dL, it seems that weight loss should be attempted to a normal body weight level.

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来源期刊

Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

4.20%

发文量

期刊介绍： The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.