老年高血压病人体质量指数与血管痉挛性心绞痛的相关性分析

doi:10.3969/j.issn.1003-9198.2025.08.016

摘要/Abstract

摘要： 目的探讨老年高血压病人BMI与血管痉挛性心绞痛(vasospastic angina, VSA)的相关性。方法本研究为回顾性病例对照研究。病例组(VSA组)为2019年1月至2024年1月在徐州市中心医院住院期间接受静息－冷加压单光子发射计算机断层心肌灌注显像(single-photon emission computed tomography myocardial perfusion imaging,SPECT MPI)并确诊为VSA的100例老年高血压病人,对照组(非VSA组)按1∶1匹配,从同期SPECT MPI检查结果正常且无VSA证据的老年高血压病人中选取。比较2组病人的年龄、性别、BMI、糖尿病及吸烟史、血脂、血糖、血肌酐、肾小球滤过率及心脏彩超等临床资料,并进一步行多因素logistic回归分析,明确BMI是否为VSA的独立相关因素。采用限制性立方样条图(RCS)明确BMI与VSA风险之间的共变关系。采用Spearman秩相关分析BMI与VSA造成的心肌缺血严重程度[心肌血流灌注负荷总积分(summed stress score,SSS),总灌注缺损(total perfusion defect,TPD)]的相关性。结果 VSA组BMI、左心室直径(LV)、短暂性缺血性扩张(TID)值、FPG、TG、TC、LDL-C及糖尿病患病率均高于非VSA组,HDL-C低于非VSA组,差异均具有统计学意义(P＜0.05)。多因素logistic回归分析结果显示,BMI、LV及糖尿病是VSA的独立危险因素(P＜0.05)。RCS曲线结果显示:BMI与VSA风险之间存在线性正相关(P_总＜0.05, P_非线性＞0.05),在BMI＞24.6的人群中,BMI的增加会加重VSA的发生风险。Spearman秩相关性分析显示,BMI与SSS及TPD分级均呈正相关(P＜0.05)。结论在老年高血压病人中,BMI是VSA的独立危险因素,且与VSA呈线性相关。BMI与VSA所致心肌缺血严重程度呈正相关。

关键词: 体质量指数, 血管痉挛性心绞痛, 老年人, 高血压, 心肌缺血

Abstract: Objective To investigate the correlation between body mass index (BMI) and vasospastic angina (VSA) in the elderly patients with hypertension. Methods This retrospective case-control study enrolled 100 elderly hypertensive patients presenting with VSA (VSA group) at Xuzhou Central Hospital from January 2019 to January 2024. The diagnosis was confirmed via rest-cold pressor single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). The control group (non-VSA group) was matched 1∶1 from elderly hypertensive patients with normal SPECT MPI results and no VSA evidence in the same period. Clinical parameters, including age, gender, BMI, diabetes, smoking history, lipid profiles, fasting plasma glucose (FPG), serum creatinine, estimated glomerular filtration rate, and echocardiographic data were compared between the two groups. Multivariate logistic regression was performed to identify independent risk factors for VSA. Restricted cubic spline (RCS) analysis was employed to evaluate the dose-response relationship between BMI and the risk of VSA. Spearman’s rank correlation was used to assess the correlation of BMI with myocardial ischemia severity such as summed stress score (SSS) and total perfusion defect (TPD). Results Compared to non-VSA group, the levels of BMI, left ventricular diameter (LV), transiet ischemic dilation (TID), FPG, triglycerides, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C)and the prevalence of diabetes were significantly higher, and the level of high-density lipoprotein cholesterol (HDL-C) was significantly lower in VSA group (all P<0.05). Multivariate logistic regression analysis showed BMI, LV and diabetes were independent risk factors for VSA (P< 0.05). RCS analysis revealed a linear positive correlation between BMI and VSA risk (P for overall trend<0.05; P for nonlinearity > 0.05). In the elderly hypertensive patients with BMI＞24.6, the increase in BMI significantly increased the risk of VSA. Spearman’s rank correlation analysis indicated a positive association between BMI and both SSS and TPD grades (P<0.05). Conclusions In the elderly hypertensive patients, BMI is an independent risk factor for VSA, with a linear dose-response relationship. Higher BMI correlates with greater severity of myocardial ischemia caused by VSA.

Key words: body mass index, vasospastic angina, aged, hypertension, myocardial ischemia

中图分类号:

R541.4

贺紫君, 郭香胜, 李振勇, 李志刚, 路雯. 老年高血压病人体质量指数与血管痉挛性心绞痛的相关性分析[J]. 实用老年医学, 2025, 39(8): 832-836.

HE Zijun, GUO Xiangsheng, LI Zhenyong, LI Zhigang, LU Wen. Correlation between body mass index and vasospastic angina in elderly patients with hypertension[J]. Practical Geriatrics, 2025, 39(8): 832-836.

参考文献

[1] MATTA A, BOUISSET F, LHERMUSIER T, et al. Coronary artery spasm: new insights[J]. J Interv Cardiol, 2020, 2020: 5894586.
[2] KOOK H, HONG S J, YANG K S, et al. Comparison of nebivolol versus diltiazem in improving coronary artery spasm and quality of life in patients with hypertension and vasospastic angina: a prospective, randomized, double-blind pilot study[J]. PLoS One, 2020, 15(9): e0239039.
[3] HELD C, HADZIOSMANOVIC N, AYLWARD P E, et al. Body mass index and association with cardiovascular outcomes in patients with stable coronary heart disease: a STABILITY substudy[J]. J Am Heart Assoc, 2022, 11(3): e023667.
[4] WADE K H, CHIESA S T, HUGHES A D, et al. Assessing the causal role of body mass index on cardiovascular health in young adults: Mendelian randomization and recall-by-genotype analyses[J]. Circulation, 2018, 138(20): 2187-2201.
[5] OHYAMA K, MATSUMOTO Y, SHIMOKAWA H. Coronary artery spasm and perivascular adipose tissue inflammation: insights from translational imaging research[J]. Eur Cardiol, 2019, 14(1): 6-9.
[6] LEE M H, JO S H, KWON S, et al. Impact of overweight/obesity on clinical outcomes of patient with vasospastic angina: from the vasospastic angina in Korea registry[J]. Sci Rep, 2020, 10(1): 4954.
[7] BELTRAME J F, CREA F, KASKI J C, et al. International standardization of diagnostic criteria for vasospastic angina[J].Eur Heart J, 2017, 38(33):2565-2568.
[8] DORBALA S, ANANTHASUBRAMANIAM K, ARMSTRONG I S, et al. Single photon emission computed tomography (SPECT) myocardial perfusion imaging guidelines: instrumentation, acquisition, processing, and interpretation[J]. J Nucl Cardiol, 2018, 25(5): 1784-1846.
[9] 鹿存芝, 骆秉铨, 王亚楠, 等. 核素TID比值诊断非梗阻性冠心病心肌缺血[J]. 标记免疫分析与临床, 2021, 28(2): 243-245, 250.
[10] POWELL-WILEY T M, POIRIER P, BURKE L E, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association[J]. Circulation, 2021, 143(21): e984-e1010.
[11] GILL D, ZUBER V, DAWSON J, et al. Risk factors mediating the effect of body mass index and waist-to-hip ratio on cardiovascular outcomes: Mendelian randomization analysis[J]. Int J Obes, 2021, 45(7): 1428-1438.
[12] LUO H, LIU Y, TIAN X, et al. Association of obesity with cardiovascular disease in the absence of traditional risk factors[J]. Int J Obes, 2024, 48(2): 263-270.
[13] DUDINA A, COONEY M T, DE BACQUER D, et al. Relationships between body mass index, cardiovascular mortality, and risk factors: a report from the SCORE investigators[J]. Eur J Cardiovasc Prev Rehabil, 2011, 18(5): 731-742.
[14] PARTO P, LAVIE C J. Obesity and cardiovascular diseases[J]. Curr Probl Cardiol, 2017, 42(11): 376-394.
[15] QUERCIOLI A, PATAKY Z, VINCENTI G, et al. Elevated endocannabinoid plasma levels are associated with coronary circulatory dysfunction in obesity[J]. Eur Heart J, 2011, 32(11): 1369-1378.
[16] TONA F, SERRA R, DI ASCENZO L, et al. Systemic inflammation is related to coronary microvascular dysfunction in obese patients without obstructive coronary disease[J]. Nutr Metab Cardiovasc Dis, 2014, 24(4): 447-453.
[17] VAN DER HEIJDEN D J, VAN LEEUWEN M A H, JANSSENS G N, et al. Body mass index is associated with microvascular endothelial dysfunction in patients with treated metabolic risk factors and suspected coronary artery disease[J]. J Am Heart Assoc, 2017, 6(9): e006082.
[18] WANG Z J, ZHOU Y J, GALPER B Z, et al. Association of body mass index with mortality and cardiovascular events for patients with coronary artery disease: a systematic review and meta-analysis[J]. Heart, 2015, 101(20): 1631-1638.
[19] HAIDAR A, HORWICH T. Obesity, cardiorespiratory fitness, and cardiovascular disease[J]. Curr Cardiol Rep, 2023, 25(11): 1565-1571.
[20] CORNEJO M A, ORTIZ R M. Body mass cycling and predictors of body mass regain and its impact on cardiometabolic health[J]. Metabolism, 2021, 125: 154912.
[21] ALMUWAQQAT Z, HUI Q, LIU C, et al. Long-term body mass index variability and adverse cardiovascular outcomes[J]. JAMA Netw Open, 2024, 7(3): e243062.