Impact of Body Mass Index on Outcomes After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

Mehta, Laxmi S.; Devlin, William; McCullough, Peter A.; O’Neill, William W.; Skelding, Kimberly A.; Stone, Gregg W.; Boura, Judith; Grines, Cindy L.

doi:10.1016/j.amjcard.2006.11.038

Cited by 121 publications

(94 citation statements)

References 13 publications

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“…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. 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.…”

Section: Discussioncontrasting

confidence: 99%

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: Discussioncontrasting

confidence: 99%

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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“…1,2 In the general population, overweight and obesity are associated with increased risk of developing cardiovascular disease, 3,4 and thus it is not surprising that in cohorts of patients with prevalent ischemic heart disease or acute coronary events, well over 50% are overweight or obese. 5,6 Despite the association between obesity and cardiovascular risk in the general population, a multitude of studies have described an inverse correlation between BMI and mortality in patients with coronary artery disease (CAD), including post-coronary revascularization patients and those with acute myocardial infarction (MI); the association between elevated BMI and improved survival has been termed the obesity paradox. 7,8 …”

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confidence: 99%

Measures of Obesity and Outcomes After Myocardial Infarction

Horwich

Fonarow

2008

Circulation

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O verweight and obesity have become increasingly common; worldwide, at least 1.1 billion adults are overweight and 312 million are obese, when overweight and obesity are defined conventionally as having a body mass index (BMI) of Ͼ25 kg/m 2 and Ͼ30 kg/m 2 , respectively. 1,2 In the general population, overweight and obesity are associated with increased risk of developing cardiovascular disease, 3,4 and thus it is not surprising that in cohorts of patients with prevalent ischemic heart disease or acute coronary events, well over 50% are overweight or obese. 5,6 Despite the association between obesity and cardiovascular risk in the general population, a multitude of studies have described an inverse correlation between BMI and mortality in patients with coronary artery disease (CAD), including post-coronary revascularization patients and those with acute myocardial infarction (MI); the association between elevated BMI and improved survival has been termed the obesity paradox. 7,8 Article p 482In this issue of Circulation, Zeller et al 9 further investigate the obesity paradox in a cohort of 2229 consecutive patients presenting with acute MI in the Côte d'Or region of France. In assessing the impact of obesity on mortality after MI, the group uses both BMI, a traditional index of obesity, as well as waist circumference, an alternate anthropometric index that is more specific for abdominal obesity. Approximately one-half of the subjects in the study were overweight (BMI 25 to 29.9 kg/m 2 ), one-quarter were obese (BMI Ͼ30 kg/m 2 ) and onehalf had increased waist circumference, which was defined as Ͼ102 cm in men and Ͼ88 cm in women. Left ventricular ejection fraction, type of MI, and acute treatment strategy did not generally differ by BMI or waist circumference values. Of note, BMI was inversely correlated with age and plasma N-terminal pro B-type natriuretic peptide, whereas waist circumference was positively correlated with age and did not correlate with N-terminal pro B-type natriuretic peptide.Consistent with prior studies, survival analysis showed that the risk of death decreased with increasing BMI tertile. In a waist-matched analysis of 832 subjects, BMI was a significant predictor of mortality, with markedly increased mortality in the low-versus high-BMI groups. However, after adjustment for age, sex, N-terminal pro B-type natriuretic peptide, and additional covariates, BMI was no longer a significant predictor of mortality in this acute MI cohort. Furthermore, waist circumference also had no effect on mortality, although multivariate analyses were not reported. The authors proceeded to stratify the cohort by both BMI and waistcircumference tertile, and identified a subgroup, namely, those with low BMI (Ͻ28 kg/m 2 ) and high waist circumference (Ͼ104 cm in women and Ͼ105 cm in men), that was at particularly high risk for 1-year mortality.Does the study by Zeller et al 9 dispel the myth of an obesity paradox in patients with CAD or MI, as described by previous investigators? Although an inverse relationshi...

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“…An apparent protective effect of high BMI on the outcome has been found in randomized trials in patients with unstable angina, NST-ACS and STEMI [4,15]. Other studies do not support this hypothesis [16,17].…”

Section: Discussionmentioning

confidence: 71%

“…Actually, this was due to the association of obesity with other co-morbidities. The use of these cardio protective drugs in obese patients was clear in many studies [4][5][6]. Obese patients usually present earlier to hospitals complaining of chest pain due to risk background and this helps in early diagnosis of myocardial infarction, better Killip class on presentation and of course better outcome and prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…That is what called "The obesity paradox" [4][5][6]. Several factors and explanations stand behind this hypothesis of "obesity paradox" for example younger age at presentation with lower coronary artery disease burden [7,8], and chronic use of cardio protective drugs for other risk factors like HTN, diabetes and dyslipidemia [4,5]. So we aimed to study the impact of BMI on the presentation and in-hospital outcome in patients presented with acute STEMI.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Body Mass Index on Presentation and Outcome of Acute ST Segment Elevation Myocardial Infarction

Arab¹,

Amin²,

Zahwy³

2017

JCCR

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Background: obesity is defined as body mass index (BMI) ≥30 kg/m 2 . Obesity is currently the most common metabolic disease. It is associated with many metabolic and cardiovascular diseases, thereby contributing to increased morbidity and mortality. Recent studies have described a better outcome of obese patients in the setting of acute ST segment elevation myocardial infarction (STEMI).Objectives: to study the impact of BMI on the presentation and in-hospital outcome of acute STEMI.Methods: a total of 140 STEMI patients were enrolled in our study, those patients were treated mainly by primary PCI. Patients were classified into two groups according to BMI; obese group with BMI ≥ 30kg/m 2 and non obese group with BMI < 30kg/m 2 . Both groups were compared regarding presentation and inhospital outcome.Results: seventy six patients (54.3%) were obese; they were significantly younger, more hypertensive, diabetic and dyslipidemic. Obese patients presented earlier (P= 0.001) and in better Killip class than non obese (P= 0.017). 37 non obese patients (57.8%) had post MI complications compared to 18 obese patients (23.7%) (P= 0.000), mainly heart failure, tachyarrhythmias, heart block and post MI angina. Patients with low BMI had complications 4 times more than patients with high BMI (Odds ratio = 4.416, 95% C.I. from 2.138 to 9.118, P< 0.001).Conclusion: the current study highlights an apparent obesity paradox showing that the non-obese STEMI patients were found to have complications 4 times more than the obese patients. Caution should be taken to prevent confusion between risk marker and risk factor.

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Impact of Body Mass Index on Outcomes After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

Cited by 121 publications

References 13 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

Measures of Obesity and Outcomes After Myocardial Infarction

Impact of Body Mass Index on Presentation and Outcome of Acute ST Segment Elevation Myocardial Infarction

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