The obesity paradox: does it carry weight in percutaneous coronary interventions?

摘要

Obesity is associated with significant morbidity and mortality and is becoming increasingly prevalent in western societies, with two thirds of this population classified as overweight or obese [1]. Overweight and obese individuals are at a greater risk of developing coronary artery disease, primarily because of obesity-related conditions, such as diabetes mellitus, hypertension and dyslipidemia [2]. Although the impact of obesity on clinical outcomes after percutaneous coronary intervention (PCI) with stents has been investigated by several studies, the issue remains complex and controversial [3-7]. A decade ago, several studies had reported better clinical outcomes in overweight and obese subjects after PCI, compared with normal and underweight subjects; an interaction termed the 'obesity paradox' [3-7]. Present data, derived from a large registry in the modern era of interventional cardiology, dismantled any 'obesity paradox' as a misnomer in the context of PCI and drug-eluting coronary stents [8]. Compared with overweight and obese patients, those with normal body weight had similar rates of all-cause mortality and major adverse cardiovascular and cerebrovascular events, as well as target-vessel revascularization, myocardial infarction, stroke and stent thrombosis, even after risk adjustment.