Impact of obesity on disease-specific health status after percutaneous coronary intervention in coronary disease patients

Abstract

OBJECTIVE: Several investigators have focused on obesity as a specific risk factor for mortality in patients undergoing bypass surgery, but few have examined it as a risk factor among patients undergoing percutaneous coronary interventions (PCI). In addition, none have evaluated the impact of obesity on post-PCI quality of life or disease-specific health status. This study examined whether obesity is a risk factor for poor quality of life or diminished health status 12-months postprocedure among a large cohort of PCI patients. RESEARCH METHODS AND PROCEDURES: A total of 1631 consecutive PCI patients were enrolled into the study and classified as underweight (BMI o20 kg/m 2 ), normal weight range (BMI Z20 and o25 kg/m 2 ), overweight (BMI Z25 and o30 kg/m 2 ), class I obese (BMI Z30 kg/m 2 ), or class II and III obese (BMI Z35 kg/m 2 ). The 12-month postprocedure outcomes included need for repeat procedure, survival, quality of life and health status, assessed using the Seattle Angina Questionnaire (SAQ) and the Short Form-12. RESULTS: Obese patients with and without a history of revascularization were significantly younger than overweight, normal weight range, or underweight patients at the time of PCI. However, obese patients demonstrated similar long-term recovery and improved disease-specific health status and quality of life when compared to patients in the normal weight range after PCI. In addition, mortality and risk for repeat procedure was similar to those patients in the normal weight range patients at 12-months postrevascularization. Underweight patients who had no previous history of revascularization reported lower quality of life (F ¼ 3.02; P ¼ 0.018) and poorer physical functioning (F ¼ 2.82; P ¼ 0.024) than other BMI groups. CONCLUSION: Obese patients presenting for revascularization were younger when compared to patients in the normal weight range, regardless of previous history of revascularization. However, weight status was not a significant predictor of differences in long-term disease-specific health status, quality of life, repeat procedures, or survival. Underweight patients demonstrated less improvement in quality of life and physical functioning than other BMI groups.

Predictors of subjective health status 10 years post-PCI

“…This is the first study that determined predictors of subjective health status 10 years post-PCI. Previous studies that determined predictors of health status post-PCI had a maximum follow-up duration of 1 year [13], [14], [15], [16], [17]. Furthermore, previous studies reported on predictors of health status after acute coronary syndrome or reported patients with coronary artery disease and not on post-PCI patients [7], [11], [31], [34], [35], [36], [37].…”

“…Only a few studies have reported on medical and psychosocial predictors of (subjective) health status post-PCI [13], [14], [15], [16], [17], [18]. Some of these studies found baseline subjective health status to be an important predictor of subjective health status post-PCI.…”

“…[13], [14], [17], [18] Furthermore, age [13], male gender, previous coronary artery bypass grafting (CABG), renal impairment [17], and smoking [16] were predictors of health status post-PCI. An important limitation of these studies was the short duration of follow-up; all these studies had a follow-up of 12 months only [13], [14], [15], [16], [17].…”

The corpulent phenotype—how the brain maximizes survival in stressful environments

“…As a consequence of such a mistake, inconsistent results have been obtained within this class of studies. For example, studies on patients with coronary artery disease included both those reporting negative associations between the BMI and mortality (Gruberg et al, 2002, 2005; Gurm et al, 2002; Powell et al, 2003; Lopez-Jimenez et al, 2004; Eisenstein et al, 2005; Kennedy et al, 2005; Sierra-Johnson et al, 2005; Nikolsky et al, 2006; Mehta et al, 2007; Lavie et al, 2011) as well as those reporting positive associations between these two variables (Rea et al, 2001; Schwann et al, 2001; Kaplan et al, 2002; De Bacquer et al, 2003; Kim et al, 2003; Kuduvalli et al, 2003; Poston et al, 2004; Rana et al, 2004; Wessel et al, 2004; Widlansky et al, 2004; Dagenais et al, 2005; Domanski et al, 2006; Martin et al, 2006; Nigam et al, 2006; Benderly et al, 2010). Such conflicts have ignited a long lasting debate.…”

Obesity and Coronary Artery Disease

“…This pertinent question has festered an ongoing debate as to the existence of the "obesity paradoxon" phenomenon in the spectrum of coronary artery disease [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”