Association of Body Mass Index With Major Cardiovascular Events and With Mortality After Percutaneous Coronary Intervention

Abstract

Background-Conflicting data exist regarding the relation between body mass index (BMI) and cardiovascular events and mortality after percutaneous coronary intervention. Methods and Results-We performed pooled analyses to evaluate the association between BMI (weight in kilograms divided by the square of the height in meters) and the risks of major cardiovascular events (defined as death from cardiovascular causes, nonfatal myocardial infarction, stent thrombosis, or stroke) and death among 23 181 patients from 11 prospective percutaneous coronary intervention studies. Overall, mean (±SD) BMI was 24.9±3.0. During follow-up (median, 2.1 years), 2381 patients had a major cardiovascular event, and 1004 patients died. After adjusting covariates, there was an inverse relationship between BMI and adverse outcomes. With a BMI of 22.5 to 24.9 as the reference category, the risk of major cardiovascular events was elevated among patients with a lower BMI (by a factor of 1.52 for a BMI <18.5; 1.05 for a BMI of 18.5-19.9; 1.03 for a BMI of 20.0-22.4); by contrast, the risk declined among patients with a higher BMI (by a factor of 0.97 for a BMI of 25.0-27.4; 0.97 for a BMI of 27.5-29.9; and 0.78 for a BMI of ≥30.0). In general, the hazard ratios for deaths were similar. Conclusions-Among patients undergoing percutaneous coronary intervention, a low BMI was associated with increased risks of major cardiovascular events and death. However, there were no excess risks of these events associated with a high BMI. (Circ Cardiovasc Interv. 2013;6:146-153.)

Effect of Obesity on Coronary Atherosclerosis and Outcomes of Percutaneous Coronary Intervention

“…[3][4][5][6] Clinical studies have reported that obese patients have better clinical outcomes, especially after PCI. 7,8 The current study suggests 1 plausible explanation for the so-called obesity paradox. Even in the setting of a greater plaque burden, a larger EEM in the high-BMI group allows for the use of larger stents and larger balloons to achieve greater stent expansion and a larger minimum stent area, especially under the IVUS guidance that was used in 95% of the patients.…”

“…1,2 Conversely, in patients with established coronary artery disease, the effect of obesity on clinical outcomes remains controversial. [3][4][5][6] Recent studies suggest that an increased body mass index (BMI) is associated with a decreased mortality and major adverse cardiac events, especially in patients who undergo percutaneous coronary intervention (PCI) 7,8 ; however, the mechanism of the so-called obesity paradox is not yet understood.Assessment of Dual Antiplatelet Therapy With DrugEluting Stents (ADAPT-DES) 9 was a large-scale, prospective, multicenter study designed to assess the relationship between platelet reactivity and other clinical and procedural variables versus subsequent stent thrombosis and other adverse clinical events in patients treated with DES. In an intravascular Background-Obesity is a cardiovascular risk factor, but the obesity paradox in patients undergoing percutaneous coronary intervention is poorly understood.…”

“…1,2 Conversely, in patients with established coronary artery disease, the effect of obesity on clinical outcomes remains controversial. [3][4][5][6] Recent studies suggest that an increased body mass index (BMI) is associated with a decreased mortality and major adverse cardiac events, especially in patients who undergo percutaneous coronary intervention (PCI) 7,8 ; however, the mechanism of the so-called obesity paradox is not yet understood.…”

Low Body Weight Is Associated With the Incidence of Stroke in Atrial Fibrillation Patients – Insight From the Fushimi AF Registry –

“…24 Fourth, low body mass index is reportedly associated with impaired endothelial dysfunction, leading to reduced bioavailability of nitric oxide, which plays a role in the regulation of vascular tone and inhioverweight patients have a higher prevalence of coexisting conditions such as hypertension, dyslipidemia, and diabetes mellitus, and they may be more likely to receive treatment for such comorbidities than LBW patients. 22 However, the higher risk of stroke/SE in the present LBW group from the Fushimi AF Registry patients persisted after adjustment for sex, age, CHADS2 score, and OAC prescription, and also persisted after adjustment for antihypertensive agents, lipid-lowering agents, Figure 3. Kaplan-Meier curves for the incidence of stroke or systemic embolism (SE) in various subgroups during follow-up period.…”

Systematic review/Meta-analysis The incidence of acute myocardial infarction in relation to overweight and obesity: a meta-analysis

“…Park et al . found that low BMI was associated with increased risks of major cardiovascular events and death among patients who underwent percutaneous coronary intervention [32]. Among overweight and obese older patients after non-ST-segment-elevation myocardial infarction, all-cause long-term mortality was lower than among those with normal weight [33].…”