Correlation and Discrepancies Between Obesity by Body Mass Index and Body Fat in Patients With Coronary Heart Disease

Schutter, Alban Md De; Lavie, Carl J.; Arce, Karla M.; Menendez, Sylvia Gra Md; Milani, Richard V.

doi:10.1097/hcr.0b013e31828254fc

Cited by 57 publications

(31 citation statements)

References 38 publications

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“…Overall, the inability of BMI to discriminate between fat‐free mass, a protective factor, and fat mass, a factor associated with adverse outcomes, may lead to erroneous assumptions about risk of MACEs in patients with CAD and may explain why, in our cohort, BMI was not associated with MACEs 5, 6, 26, 27. Thus, the results of our study could not confirm the obesity paradox that has been reported in several other studies in those with CAD,28, 29, 30, 31, 32 heart failure,33, 34, 35, 36 and atrial fibrillation 37.…”

Section: Discussionmentioning

confidence: 94%

“…The obesity paradox was addressed in a large meta‐analysis of patients with CAD, where it was observed that subjects with a low BMI had an increased relative risk for total mortality and cardiovascular mortality, whereas obese patients had no increased risk or even a lower risk for total mortality or cardiovascular mortality 3. Results showing the obesity paradox could be partially explained by the poor diagnostic accuracy of BMI to detect adiposity and its inability to differentiate between fat‐free and fat mass, particularly among patients with CAD 5, 6, 20. For example, a lower BMI could be related to sarcopenia rather than low fat mass, while being overweight may reflect increased muscle mass, rather than excessive adipose tissue.…”

Section: Discussionmentioning

confidence: 99%

“…However, numerous publications have demonstrated the existence of an “obesity paradox,” where overweight and obese people with CAD or heart failure have a better prognosis than normal weight people with similar conditions and cardiovascular risk factors 3. Although the cause for the obesity paradox is unclear, several factors can contribute to it, such as the inability of the body mass index (BMI) to distinguish between body fat (BF) mass and fat‐free mass in the general population4 and particularly in patients with CAD 5, 6. Because of the fact that fat‐free mass has protective metabolic effects, the inability of BMI to discriminate between fat‐free and fat mass may lead to erroneous assumptions about the association between fatness and prognosis in patients with CAD.…”

Section: Introductionmentioning

confidence: 99%

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Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Medina‐Inojosa

Somers

Thomas

et al. 2018

JAHA

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BackgroundPrognosis based on body fat percentage (BF%) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF% have a higher risk for major adverse cardiovascular events (MACEs) and that fat‐free mass is associated with better prognosis.Methods and ResultsWe included 717 patients referred to cardiac rehabilitation after coronary artery disease events or procedures who underwent air displacement plethysmography to assess BF%; 75% were men, with a mean age 61.4±11.4 years and a mean body mass index of 30±5.4 kg/m2. Follow‐up was performed using a record linkage system. Patients were classified in sex‐specific quartiles of BF% and fat‐free mass index. The composite outcome of MACEs included acute coronary syndromes, coronary revascularization, stroke, or death from any cause. After a median follow‐up of 3.9 years, 201 patients had a MACE. After adjusting for covariates, body mass index was not associated with MACEs (P=0.12). However, the risk of MACEs for those in the highest BF% quartile was nearly double when compared with those in the lowest quartile (hazard ratio, 1.89; 95% confidence interval, 1.30–2.77; P=0.0008). In contrast, fat‐free mass was inversely associated with MACEs. The risk of MACEs for those in the fourth fat‐free mass quartile was lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.35–0.82; P=0.004), when compared with those in the first quartile.ConclusionsIn patients with coronary artery disease, there is no obesity paradox when measuring BF% instead of body mass index. BF% is associated with a higher risk of MACEs, whereas fat‐free mass is associated with a lower risk of MACEs. Body mass index was not associated with MACEs.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Medina‐Inojosa

Somers

Thomas

et al. 2018

JAHA

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“…Many reports documented the efficacy of BMI on reflecting body fat and concluded that BMI correlates with the body fat amount and is still the most practical and commonly used test for defining obesity (4).…”

Section: Discussionmentioning

confidence: 99%

Obesity is still a risk factor in coronary artery bypass surgery

Gürbüz¹,

Durukan²,

Salman³

et al. 2014

Anadolu Kardiyol Derg

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Objective: Even with the improvements in surgical techniques and perioperative care, obesity is still a risk factor for occurrence of adverse events following cardiac surgery. In this observational, retrospective study, we aimed to document the effects of obesity on surgical outcomes in patients undergoing coronary artery bypass surgery and find out the effects of improvements in cardiac surgery. Methods: Between January 2011 and March 2013, isolated coronary artery bypass surgery was performed on 790 patients. The body mass index values of the patients were calculated and patients were divided into two groups; below 30 were classified as non-obese group whereas above 30 were classified as obese group. The odds ratio was obtained by using univariate analysis in order to document the effects of obesity on outcomes.Results: There were 548 (69.3%) patients in non-obese group, whereas 242 (30.7%) patients in obese group. The cardiopulmonary bypass (80.47±23.58 vs. 80.89±28.46, p=0.449) and aortic clamp times (54.13±16.60 vs. 54.19±19.85, p=0.511) and number of bypass grafts (3.09±1.02 vs. 2.96±1.00, p=0.11) were comparable between the groups. The mean number of fresh frozen plasma used was higher in obese patients (1.37±1.75 vs. 1.48±4.63, p=0.02). Intubation time was higher in obese patients (10.57±6.87 vs. 12.71±35.31, p=0.014). Total amount of postoperative drainage was higher in non-obese patients (766.77±472.27 vs. 648.72±371.39, p<0.001). The superficial infection/mediastenitis (0.4% vs. 2.5%, p=0.012), dehiscence (0.2% vs. 3.7%, p<0.001) and postoperative renal failure rates (4.7% vs. 8.7%, p=0.031) were higher in obese patients. The incidence of atrial fibrillation was lower in obese patients (19.7% vs. 12.8%, p=0.019). The mortality (0.5% vs. 1.7%, p=0.210) and postoperative stroke rates (1.1% vs. 0.8%, p=1.000) were similar in both groups. Conclusion: We documented that obesity is still a risk factor for occurrence of postoperative adverse events. We believe that improved perioperative care together with meticulous regimens can improve postoperative outcomes in patients undergoing coronary artery bypass surgery.

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“…Even though BMI and waist circumference are the most frequently used obesity indices, they can poorly differentiate regional fat distribution and therefore, are critiqued for their accuracy in defining obesity [13] . Visceral adiposity has been demonstrated to be associated with increased risk of atherosclerotic cardiovascular diseases even after adjustment for BMI and other clinical risk factors [14,15] .…”

Section: Baseline Data Collectionmentioning

confidence: 99%

Visceral Fat Is an Independent Predictor of Cerebral Microbleeds in Neurologically Healthy People

Kwon

Park

et al. 2016

Cerebrovasc Dis

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Background: Obesity has a significant contribution to the risk of intracerebral hemorrhage (ICH). However, little is known about the association between central obesity and the presence of cerebral microbleeds (CMBs), a precursor of ICH. We sought to assess whether visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) are associated with the presence of CMB. Methods: We conducted a cross-sectional study of 1,737 neurologically healthy people (mean age 55.9 ± 9.1; 790 men), who underwent brain MRI and abdominal CT. Risk factors, anthropometric parameters and clinical information were obtained. CMBs were evaluated through T2*-weighted gradient-recalled echo MRI. The cross-sectional surface areas of the abdominal fat compartments were calculated. Study subjects were stratified into quartiles according to the distribution of VAT/SAT ratio. Results: A total of 75 (4.3%) subjects were found to have CMBs. Subjects with a greater quartile of VAT/SAT ratio were more likely to have higher numbers of CMBs (0 to ≥2; p = 0.001). In multivariable analysis, age and history of hypertension were associated with the presence of CMB (OR 1.09, 95% CI 1.06-1.13, p < 0.001; OR 1.70, 95% CI 1.01-2.84, p = 0.046, respectively). A dose-response relationship was observed between the extent of VAT/SAT quartile and CMB: compared to the lowest VAT/SAT quartile, OR 2.14 (95% CI 0.86-5.35) for second VAT/SAT quartile; OR 2.26 (95% CI 0.86-5.92) for third VAT/SAT quartile; and OR 2.91 (95% CI 1.04-8.12) for the highest VAT/SAT quartile (p for trend 0.03). Conclusion: In our study, higher VAT/SAT ratios were found to be independent predictors of CMBs in neurologically healthy people. This finding strengthens previous data, suggesting that visceral fat distribution is an important contributor to cerebral small vessel disease.

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Correlation and Discrepancies Between Obesity by Body Mass Index and Body Fat in Patients With Coronary Heart Disease

Cited by 57 publications

References 38 publications

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

Obesity is still a risk factor in coronary artery bypass surgery

Visceral Fat Is an Independent Predictor of Cerebral Microbleeds in Neurologically Healthy People

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