INTRODUCTION This meta-analysis brings comprehensive evaluation about still controversial association between the body mass index (BMI) and the outcomes of acute coronary syndrome (ACS). METHODS PubMed/ScienceDirect databases were systematically searched for studies with baseline parameters, primary (heart failure (HF), cardiogenic shock, cardiac arrest, reinfarction, stroke, death, total in-hospital complications) and secondary outcomes (reinfarction, stroke, death, total major adverse cardiovascular events (MACE)) in relation to BMI strictly classified into four groups (Underweight (<18.5 kg/m2), Normal weight (18.5-24.9 kg/m2), Overweight (25.0-29.9 kg/m2) and Obese (≥30.0 kg/m2), grouped into Mildly Obese (30.0-34.9 kg/m2) and Severely Obese (≥35.0 kg/m2)). RESULTS We included 24 studies, with 585,919 participants (55.5% males), aged 66.8 years. Underweight was negatively associated with hypertension, hyperlipidemia and diabetes, and positively with primary outcomes (HF (Odds ratio (OR)=1.37, Confidence interval (CI) [1.15-1.63]), cardiogenic shock (OR=1.43, CI [1.04-1.98]), stroke (OR=1.21, CI [1.05-1.40]), overall death (OR=1.64, CI [1.20-2.26]), total in-hospital complications (OR=1.39, CI [1.24-1.56])) and secondary outcomes during 34-month follow-up (cardiovascular/overall death (OR=3.78, CI [1.69-8.49]/OR=2.82, CI [2.29-3.49]), respectively), total MACE (OR=2.77, CI [2.30-3.34])) (for all P<0.05). Obesity had positive association with hypertension, hyperlipidemia, diabetes and smoking, and negative with primary outcomes (reinfarction (OR=0.83, CI [0.76-0.91]), stroke (OR=0.67, CI [0.54-0.85]), overall death (OR=0.55, CI [0.49-0.63]), total in-hospital complications (OR=0.81, CI [0.70-0.93])) and secondary outcomes (cardiovascular/overall death (OR=0.77, CI [0.66-0.88]/OR=0.62, CI [0.53-0.72]), respectively), total MACE (OR=0.63, CI [0.60-0.77])) (for all P<0.05). This negative association with several primary outcomes (cardiogenic shock, overall death, total in-hospital complications) and secondary outcomes (cardiovascular/overall death, total MACE) was more pronounced in mild obesity (P<0.05). These results give an "obesity paradox" with a bimodal pattern (slightly U-shaped). CONCLUSION Obesity is positively associated with traditional cardiovascular risk factors and negatively with primary and secondary outcomes, which confirms the persistence of overall "obesity paradox".

中文翻译：

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急性冠脉综合征院内和随访阶段的肥胖悖论：荟萃分析和系统评价。

引言 这项荟萃分析对体重指数 (BMI) 与急性冠脉综合征 (ACS) 结果之间仍存在争议的关联进行了全面评估。方法 系统地检索 PubMed/ScienceDirect 数据库中的研究，包括基线参数、主要结局（心力衰竭 (HF)、心源性休克、心脏骤停、再梗塞、中风、死亡、总院内并发症）和次要结局（再梗塞、中风、死亡、与BMI相关的总主要不良心血管事件（MACE））严格分为四组（体重不足（<18.5 kg/m2）、正常体重（18.5-24.9 kg/m2）、超重（25.0-29.9 kg/m2）和肥胖（≥30.0 kg/m2），分为轻度肥胖（30.0-34.9 kg/m2）和重度肥胖（≥35.0 kg/m2）。结果 我们纳入了 24 项研究，共有 585,919 名参与者（55.5% 为男性），年龄为 66.8 岁。体重不足与高血压、高脂血症和糖尿病呈负相关，与主要结局（HF（比值比 (OR)=1.37，置信区间 (CI) [1.15-1.63]）、心源性休克（OR=1.43，CI [1.04- 1.98]）、卒中（OR=1.21，CI [1.05-1.40]）、总死亡（OR=1.64，CI [1.20-2.26]）、总院内并发症（OR=1.39，CI [1.24-1.56]） ）和 34 个月随访期间的次要结局（心血管/总体死亡（分别为 OR=3.78，CI [1.69-8.49]/OR=2.82，CI [2.29-3.49]））、总 MACE（OR=2.77， CI [2.30-3.34]))（所有 P<0.05）。肥胖与高血压、高脂血症、糖尿病和吸烟呈正相关，与主要结局（再梗死（OR=0.83，CI [0.76-0.91]）、卒中（OR=0.67，CI [0.54-0.85]）、总体死亡（ OR=0.55，CI [0.49-0.63]）、总住院并发症（OR=0.81，CI [0.70-0.93]））和次要结局（心血管/总体死亡（OR=0.77，CI [0.66-0.88]）/ OR=0.62，CI [0.53-0.72]），总 MACE（OR=0.63，CI [0.60-0.77]））（所有 P<0.05）。这种与几个主要结局（心源性休克、总死亡、总院内并发症）和次要结局（心血管/总死亡、总 MACE）的负相关在轻度肥胖中更为明显（P<0.05）。这些结果给出了具有双峰模式（略呈 U 形）的“肥胖悖论”。结论 肥胖与传统心血管危险因素呈正相关，与主要和次要结局呈负相关，这证实了整体“肥胖悖论”的持续存在。