심근경색과 비만 패러독스
‘Obesity Paradox’ in Myocardial Infarction Patients
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연구배경: 비만은 심근경색의 위험요인이며 그 부정적인 영향에도 불구하고 여러 연구에서 정상체중보다 좋은예후를 초래하는 것으로 보고되어 이를 비만 패러독스라고 부른다. 일차적 관상동맥중재술 후 심근경색 환자들의예후와 관련하여 체질량지수의 영향에 관하여는 많은 논란이 있다. 방법: 연구 대상자는 2009년 1월에서 2011년 9월 사이에일차적 관상동맥중재술을 실시한 457명이다. 이들은 체질량지수에 따라 정상체중군(<23 kg/m2), 과체중군(23-25kg/m2), 비만군(>25 kg/m2)으로 분류되었다. 세 군의 임상적 특성, 심혈관계 위험요인, 그리고 주요심장사건에 관하여 비교하였고 다변량분석을 통해 주요심장사건의 예측인자를 분석하였다. 결과: 본 연구 대상자들에서는 체질량지수가 정상인 환자는 과체중 또는 비만인 환자에 비해 심근경색의 발병연령이 낮았고(P<0.001) 좌심실 박출률이 높았으며(P=0.012)사망을 비롯한 주요심장사건의 발생이 적게(P=0.003) 나타났다. 다변량로지스틱회귀분석 결과 사망률 및 주요심장사건의 유의한 예측인자는 체질량지수가 아니라 연령(P=0.006, P=0.017)과 고밀도콜레스테롤(P=0.002, P=0.005),좌심실 박출률(P=0.001, P<0.001)로 나타났다. 결론: 체질량지수는 심근경색 환자에서 사망 및 주요심장사건 발생에 의미있는 예측인자가 아니며 비만한 환자가 보다 젊은 나이에 심근경색이 발생했기 때문에 나타난현상으로 볼 수 있다.
Abstract
Background: Despite the adverse impact that being overweight or obese has on cardiovascular disorders, numerous studies have addressed the ‘obesity paradox’, which suggests that obese persons seem to have a better prognosis with these conditions than those with a normal body mass index (BMI). In addition, the effect of BMI on outcomes after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) remains controversial. Methods: Our subjects included 457 patients who had undergone PCI for AMI between January 1, 2009 and September 30, 2011. They were classified into 3 groups according to baseline BMI - normal weight (BMI<23kg/m2), overweight (BMI 23-25 kg/m2), obesity (BMI>25 kg/m2). Clinical characteristic and cardiovascular risk factors and major adverse cardiac events (MACE), including death after PCI, were compared among the groups. Results: Overweight or obese subjects were younger (P<0.001) and associated with higher left ventricle ejection fraction (LVEF) (P=0.012) and less frequency of MACE (P=0.003). Multiple logistic regression analysis showed that independent predictors for death and MACE were not obesity but age (P=0.006, P=0.017),high-density lipoprotein cholesterol (P=0.002, P=0.005) and LVEF (P=0.001, P<0.001). Conclusions: In our study, BMI had no effect on MACE in patients undergoing primary PCI for AMI. The phenomenon,'obesity paradox', may be explained by the possibility that AMI was diagnosed at a younger age in obese patients and that these younger patients had higher LVEFs than the other groups in this study.
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