Body mass index and outcome in patients with coronary, cerebrovascular, or peripheral artery disease: findings from the FRENA registry

Barba, Raquel; Bisbe, Josep; Pedrajas, José Nicolás Alcalá; Toril, Jesús; Monte, Rafael; Muñoz-Torrero, Juan Francisco Sánchez; Monréal, Manuel

doi:10.1097/hjr.0b013e32832b1818

Cited by 39 publications

(30 citation statements)

References 40 publications

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“…Goessens et al, 22 who investigated the prognostic impact of various cardiovascular risk factors in 461 symptomatic PAD patients (Fontaine's stage II to IV) participating in the SMART study, observed that BMI was not a significant predictor of cardiovascular events (HR ¼ 1.01; 95% CI 0.96-1.07). More recently, Barba et al 23 observed that PAD patients showed an inverse relationship between BMI and cardiovascular mortality, which is consistent with the so-called obesity paradox that has been observed in subjects with multiple atherosclerotic risk factors, patients with heart failure, and those with coronary artery disease. 7,8,38 Consistently, in a non-homogeneous population of 2302 patients who underwent major vascular surgery (lower-limb revascularization procedures, carotid endarterectomy or abdominal aortic surgery), Galal et al 24 found that the higher the BMI, the lower the mortality rate.…”

Section: Discussionmentioning

confidence: 48%

“…Nevertheless, very few studies have investigated the relationship between obesity and occurrence of cardiovascular events in PAD; moreover, with conflicting results. [21][22][23][24] This prompted us to conduct a prospective study aimed at evaluating the prognostic impact of obesity in a homogeneous cohort of PAD patients. Furthermore, as no study of obesity in PAD investigated the joint and independent effects of general and abdominal obesity, the secondary aim of our study was to compare the predictive value of BMI (an index of general obesity) and WC (an index of abdominal obesity).…”

Section: Introductionmentioning

confidence: 99%

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The prognostic impact of general and abdominal obesity in peripheral arterial disease

et al. 2009

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Objective: Obesity is an independent cardiovascular risk factor, but its prognostic role in patients with peripheral arterial disease (PAD) is not well defined. Accordingly, we assessed the impact of body mass index (BMI) and waist circumference (WC) on cardiovascular risk in a homogeneous cohort of PAD patients. Methods: BMI and WC were measured in 190 consecutive PAD patients with ABI o0.90, referred to our university hospital for intermittent claudication. The occurrence of cardiac, cerebrovascular and peripheral events was prospectively assessed. The ability to classify risk was determined by calculating the hazard ratios (HRs) and c-statistics. Results: During a median follow-up of 31.5 months, 63 patients (33.2%) had a cardiovascular event. Considered as continuous variables, both adiposity indices were significantly associated with increased cardiovascular risk, even after adjustment for possible confounding factors (HR ¼ 1.08, 95% CI 1.01-1.15, P ¼ 0.045 for BMI and HR ¼ 1.04, 95% CI 1.01-1.07, P ¼ 0.004 for WC). When BMI and WC were included together in a fully adjusted Cox model, the significant association between BMI and cardiovascular risk disappeared (HR ¼ 0.98, 95% CI 0.88-1.10, P ¼ 0.772), whereas WC remained significantly associated with a worse outcome (HR ¼ 1.04, 95% CI 1.01-1.08, P ¼ 0.033). The better discriminative ability of WC vs BMI was confirmed by the c-statistic, which was significantly higher for WC (0.63, 95% CI 0.56-0.70) than for BMI (0.56, 95% CI 0.51-0.63, P ¼ 0.038). Conclusions: Abdominal obesity and, to a lesser degree, general obesity worsen the prognosis of PAD patients independently of possible confounding factors. Weight reduction should be integrated in the active management of these patients.

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Section: Discussionmentioning

confidence: 48%

Section: Introductionmentioning

confidence: 99%

The prognostic impact of general and abdominal obesity in peripheral arterial disease

et al. 2009

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“…12 In the FRENA registry, it was found that the patients with PAD showed an inverse correlation between BMI and cardiovascular mortality. 13 In the present study, the BMI of patients with PAD was lower than that of patients without PAD. But as the difference was so small, its clinical significance was obscure.…”

Section: Risk Factorsmentioning

confidence: 73%

Preventive Effects of Eicosapentaenoic Acid on Coronary Artery Disease in Patients With Peripheral Artery Disease - Subanalysis of the JELIS Trial -

Ishikawa¹,

Yokoyama

Saitō

et al. 2010

Circ J

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he Japan eicosapentaenoic acid (EPA) lipid intervention study (JELIS) was the first large-scale randomized trial that examined the preventive effects of EPA in patients with hypercholesterolemia at risk of developing coronary artery disease (CAD). A major finding of JELIS was that EPA at the daily dose of 1,800 mg significantly reduced the incidence of major coronary events (MCE) by 19% (hazard ratio 0.81, 95% confidence interval (95%CI) 0.69-0.95, P=0.011). 1 The subanalysis of JELIS showed that EPA reduced the incidence of recurrent stroke. 2 In the primary prevention group, EPA also reduced the incidence of CAD in the high-risk group. 3 Editorial p 1298Among atherosclerotic risk factors, age and total cho-

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“…A direct comparison of the relation between general adiposity, as measured by body mass index (BMI), and vascular risk between groups of patients with various clinical manifestations of vascular diseases showed an inverse relationship between BMI and vascular mortality in patients with CAD or PAD, but not in patients with previous stroke or transient ischaemic attack. 21 The primary objective of the present prospective cohort study was to directly compare the risk of general adiposity and abdominal obesity on the occurrence of vascular events and mortality in patients with various clinical manifestations of vascular disease.…”

Section: Introductionmentioning

confidence: 99%

The risk of general and abdominal adiposity in the occurrence of new vascular events and mortality in patients with various manifestations of vascular disease

Kappelle

et al. 2011

Int J Obes

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Aims: Adiposity is associated with an increased but also with a decreased risk for successive vascular events or mortality in patients with different manifestations of vascular disease. In this study we directly compare the risk of general adiposity or abdominal obesity on the occurrence of new vascular events or mortality in these patients. Methods: Patients with cerebrovascular disease (CVD; n ¼ 973), coronary artery disease (CAD; n ¼ 2339) or peripheral arterial disease (PAD; n ¼ 894) were prospectively followed for the occurrence of a vascular event or death. The median follow-up was 4.5 years. Adiposity was assessed with body mass index (BMI), waist circumference (WC) and determination of intra-abdominal fat through ultrasound. Cox proportional hazards models were used to evaluate the risk for new vascular events, vascular mortality and all-cause mortality. Results: CAD patients had a 12% increased risk for vascular mortality with 1 BMI unit increase (hazard ratio (HR) 1.12; 95% confidence interval (CI) 1.05-1.20) and a 25% increased risk with 1cm increase in intra-abdominal adipose tissue (HR 1.25; 95% CI 1.12-1.39). The risk for all-cause mortality was increased by 3% (HR 1.03; 95% CI 1.01-1.05) with 1 cm increase in WC and was increased by 15% (HR 1.15; 95% CI 1.06-1.25) with 1 cm increase in intra-abdominal adipose tissue. In PAD patients there was an inverse relationship between BMI and vascular mortality (HR 0.93;) and all-cause mortality (HR 0.90; 95% CI 0.86-0.94). In CVD patients there was no relation between obesity and vascular events or mortality. Conclusion: General adiposity is associated with an increased risk for vascular mortality in CAD patients and a decreased risk for (vascular) mortality in PAD patients.

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Body mass index and outcome in patients with coronary, cerebrovascular, or peripheral artery disease: findings from the FRENA registry

Abstract: Patients with CAD or PAD (not those with cerebrovascular disease) have an inverse correlation between BMI and cardiovascular mortality, even after adjusting for confounding variables.

Cited by 39 publications

References 40 publications

The prognostic impact of general and abdominal obesity in peripheral arterial disease

The prognostic impact of general and abdominal obesity in peripheral arterial disease

Preventive Effects of Eicosapentaenoic Acid on Coronary Artery Disease in Patients With Peripheral Artery Disease - Subanalysis of the JELIS Trial -

The risk of general and abdominal adiposity in the occurrence of new vascular events and mortality in patients with various manifestations of vascular disease

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