Obesity paradox in a cohort of 4880 consecutive patients undergoing percutaneous coronary intervention

Hastie, Claire E.; Padmanabhan, Sandosh; Slack, Rachel D.; Pell, Alastair C H; Oldroyd, Keith G.; Flapan, Andrew D.; Jennings, K.; Irving, John; Eteiba, Hany; Dominiczak, Anna F.; Pell, Jill P.

doi:10.1093/eurheartj/ehp317

“…1 Besides being a risk factor for CHD, obesity is associated with increased risk of the most common CV diseases, including HTN, HF, atrial fibrillation, as well as many other CV diseases, as we have reviewed previously. 1,2,20 However, despite this powerful association between obesity and CHD risk factors, CHD, and most CV diseases, numerous studies have now demonstrated that in cohorts with established CV diseases, including HTN, HF, periph- Many studies have now demonstrated this obesity paradox in CHD cohorts, [5][6][7] including patients with CHD with and without revascularization procedures. 8 In a meta-analysis from Mayo Clinic, Romero-Corral et al 8 analyzed 40 cohort studies totaling more than 250,000 patients with CHD grouped according to BMI.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The obesity paradox has also been demonstrated in non-CV studies that included patients with advanced renal disease and the elderly. 3,4 Many large studies of cohorts with CHD have demonstrated this obesity paradox, [5][6][7] which has also been demonstrated in a large meta-analysis by Romero-Corral et al 8 from Mayo Clinic, who analyzed 40 cohort studies totaling more than 250,000 patients with CHD grouped according to BMI.…”

mentioning

confidence: 80%

“…1,2 The obesity paradox has also been demonstrated in non-CV studies that included patients with advanced renal disease and the elderly. 3,4 Many large studies of cohorts with CHD have demonstrated this obesity paradox, [5][6][7] which has also been demonstrated in a large meta-analysis by Romero-Corral et al 8 from Mayo Clinic, who analyzed 40 cohort studies totaling more than 250,000 patients with CHD grouped according to BMI.Although BMI is the most frequently used method to assess overweightness/obesity, especially in large epidemiologic studies, this method has been criticized because BMI does not always reflect true body fatness. 1,2,9-14 Some investigators have theorized that at least part of the inconsistent relationship between obesity and major CV disease events, including mortality, may be due to the inaccurate diagnosis of obesity by the BMI assessment and that defining obesity by other methods, including waist circumference, waist/hip ratio, as well as percent body fat (BF) may be more accurate.…”

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confidence: 99%

See 1 more Smart Citation

Body Composition and Coronary Heart Disease Mortality—An Obesity or a Lean Paradox?

Lavie¹,

Schutter²,

Patel³

et al. 2011

Mayo Clinic Proceedings

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Body Composition and Heart disease mortalityFor personal use. Mass reproduce only with permission from Mayo Clinic Proceedings a .D espite the well-known adverse affects of obesity on almost all aspects of coronary heart disease (CHD) and CHD risk factors, including hypertension (HTN), plasma lipids, inflammation, glucose abnormalities, insulin resistance, metabolic syndrome and type 2 diabetes mellitus (T2DM), as well as left ventricular hypertrophy (LVH), many studies of cohorts with established cardiovascular (CV) disease, including heart failure (HF), HTN, as well as CHD, have demonstrated an inverse relationship between obesity, generally determined by body mass index (BMI [calculated as the weight in kilograms divided by the height in meters squared]), on subsequent mortality, referred to as the obesity paradox. 1,2 The obesity paradox has also been demonstrated in non-CV studies that included patients with advanced renal disease and the elderly. 3,4 Many large studies of cohorts with CHD have demonstrated this obesity paradox, [5][6][7] which has also been demonstrated in a large meta-analysis by Romero-Corral et al 8 from Mayo Clinic, who analyzed 40 cohort studies totaling more than 250,000 patients with CHD grouped according to BMI.Although BMI is the most frequently used method to assess overweightness/obesity, especially in large epidemiologic studies, this method has been criticized because BMI does not always reflect true body fatness. 1,2,9-14 Some investigators have theorized that at least part of the inconsistent relationship between obesity and major CV disease events, including mortality, may be due to the inaccurate diagnosis of obesity by the BMI assessment and that defining obesity by other methods, including waist circumference, waist/hip ratio, as well as percent body fat (BF) may be more accurate. 2,[9][10][11][12][13] We have recently demonstrated this obesity paradox in a cohort of CHD patients using both BMI and BF determinations. 14 To our knowledge, no prior studies have determined the independent effects of both BMI and BF on mortality in a cohort of CHD patients. Therefore, in the current evaluation, we determined the combined and independent impact of both BMI and BF on mortality in a cohort with stable CHD. PATIENTS AND METHODSWe retrospectively reviewed the case records of 581 consecutive patients with stable CHD who were referred for potential entry into formal cardiac rehabilitation programs between January 1, 2000, and July 31, 2005, and who had baseline anthropometric, lipid, and clinical data, as we have previously described. 14 Patients were divided into low (<25) and high (≥25) BMI. Elevated BF has been defined as greater than 25% in men and greater than 35% in women, 15,16 so patients were also divided into low (≤25% men and ≤35% women) and high BF (>25% men and >35% women Objective: To determine the combined effects of body mass index (BMI) and body fat (BF) on prognosis in coronary heart disease (CHD) to better understand the obesity paradox. Patients and MethOds:We s...

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“…29, 30 However, in our population, obese patients had similar ages (65 ± 9 years) to overweight (64 ± 9 years) and normal BMI patients (65 ± 10 years, p=NS). Multivariate analysis also adjusted the results for age.…”

Section: Discussionmentioning

confidence: 50%

Does metabolic syndrome predict significant angiographic coronary artery disease?

Timóteo

¹

,

Carmo

²

,

Ferreira

³

2012

Revista Portuguesa de Cardiologia (English Edition)

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Introduction: Metabolic syndrome (MS) is an independent predictor of acute cardiovascular events. However, few studies have addressed the relationship between MS and stable angiographic coronary artery disease (CAD), which has a different pathophysiological mechanism. We aimed to study the independent predictors for significant CAD, and to analyze the impact of MS (by the AHA/NHLBI definition) on CAD. Methods: We prospectively included 300 patients, mean age 64 ± 9 years, 59% male, admitted for elective coronary angiography (suspected ischemic heart disease), excluding patients with known cardiac disease. All patients underwent assessment of demographic, anthropometric, and laboratory data and risk factors, and subsequently underwent coronary angiography. Results: In the study population, 23.0% were diabetic, 40.5% had MS (and no diabetes) and 36.7% had neither diagnosis. Significant CAD was present in 51.3% of patients. CAD patients were older and more frequently male and diabetic, with increased triglycerides and glucose and lower HDL cholesterol. Abdominal obesity was also less prevalent. MS was not associated with the presence of CAD (OR 0.94, 95% CI 0.59---1.48, p=0.778). Of the MS components, the most important predictors of CAD were increased glucose and triglycerides. Abdominal obesity was associated with a lower risk of CAD. In a multivariate logistic regression model for CAD, independent predictors of CAD were age, male gender, glucose and triglycerides. Body mass index had a protective effect. Conclusions: Although MS is associated with cardiovascular events, the same was not found for stable angiographically proven CAD. Age, gender, diabetes and triglycerides are the most influential factors for CAD, with abdominal obesity as a protective factor. Resumo Introdução: A síndrome metabólica (SM) é um predizente independente de eventos cardiovasculares agudos. Contudo, pouco estudos analisaram a relação entre SM e doença arterial coronária angiográfica estável (DAC), que apresenta uma diferente mecanismo fisiopatológico. Procurámos identificar os factores predizentes independentes para DAC e analisar o impacto da presença de SM (pela definição da AHA/NHLBI) na DAC. Métodos: Analisamos prospectivamente 300 indivíduos, com idade media de 64 ± 9 anos, 59% do género masculino, admitidos para angiografia coronária eletiva por suspeita de cardiopatia isquémica, tendo sido excluídos os doentes com antecedentes de doença cardíaca. Todos os doentes foram submetidos a avaliação demográfica, antropométrica, fatores de risco e laboratorial e subsequentemente a coronariografia. Resultados: Na população do estudo, 23,0% eram diabéticos, 40,5% tinha SM (sem diabetes) e 36,7% nenhum dos anteriores diagnósticos. Verificou-se DAC significativa em 51,3% dos doentes. Estes doentes tinham mais idade, mais do género masculino, diabéticos, com triglicéridos e glicemia aumentados e colesterol-HDL baixo. A obesidade abdominal era também menos prevalente. A SM não se associou com a presença de DAC (OR 0,94, IC 95% 0,59--...

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“…Other authors have explained this inverse relationship, described as the obesity paradox, as a result of bias caused by different baseline characteristics, since these patients are usually younger. 29,30 However, in our population, obese patients had similar ages (65 ± 9 years) to overweight (64 ± 9 years) and normal BMI patients (65 ± 10 years, p=NS). Multivariate analysis also adjusted the results for age.…”

Section: Discussionmentioning

confidence: 50%

Does metabolic syndrome predict significant angiographic coronary artery disease?

Timóteo

¹

,

Carmo

²

,

Ferreira

³

2012

Revista Portuguesa de Cardiologia

4

0

View full text Add to dashboard Cite

Introduction: Metabolic syndrome (MS) is an independent predictor of acute cardiovascular events. However, few studies have addressed the relationship between MS and stable angiographic coronary artery disease (CAD), which has a different pathophysiological mechanism. We aimed to study the independent predictors for significant CAD, and to analyze the impact of MS (by the AHA/NHLBI definition) on CAD. Methods: We prospectively included 300 patients, mean age 64 ± 9 years, 59% male, admitted for elective coronary angiography (suspected ischemic heart disease), excluding patients with known cardiac disease. All patients underwent assessment of demographic, anthropometric, and laboratory data and risk factors, and subsequently underwent coronary angiography. Results: In the study population, 23.0% were diabetic, 40.5% had MS (and no diabetes) and 36.7% had neither diagnosis. Significant CAD was present in 51.3% of patients. CAD patients were older and more frequently male and diabetic, with increased triglycerides and glucose and lower HDL cholesterol. Abdominal obesity was also less prevalent. MS was not associated with the presence of CAD (OR 0.94, 95% CI 0.59---1.48, p=0.778). Of the MS components, the most important predictors of CAD were increased glucose and triglycerides. Abdominal obesity was associated with a lower risk of CAD. In a multivariate logistic regression model for CAD, independent predictors of CAD were age, male gender, glucose and triglycerides. Body mass index had a protective effect. Conclusions: Although MS is associated with cardiovascular events, the same was not found for stable angiographically proven CAD. Age, gender, diabetes and triglycerides are the most influential factors for CAD, with abdominal obesity as a protective factor. Resumo Introdução: A síndrome metabólica (SM) é um predizente independente de eventos cardiovasculares agudos. Contudo, pouco estudos analisaram a relação entre SM e doença arterial coronária angiográfica estável (DAC), que apresenta uma diferente mecanismo fisiopatológico. Procurámos identificar os factores predizentes independentes para DAC e analisar o impacto da presença de SM (pela definição da AHA/NHLBI) na DAC. Métodos: Analisamos prospectivamente 300 indivíduos, com idade media de 64 ± 9 anos, 59% do género masculino, admitidos para angiografia coronária eletiva por suspeita de cardiopatia isquémica, tendo sido excluídos os doentes com antecedentes de doença cardíaca. Todos os doentes foram submetidos a avaliação demográfica, antropométrica, fatores de risco e laboratorial e subsequentemente a coronariografia. Resultados: Na população do estudo, 23,0% eram diabéticos, 40,5% tinha SM (sem diabetes) e 36,7% nenhum dos anteriores diagnósticos. Verificou-se DAC significativa em 51,3% dos doentes. Estes doentes tinham mais idade, mais do género masculino, diabéticos, com triglicéridos e glicemia aumentados e colesterol-HDL baixo. A obesidade abdominal era também menos prevalente. A SM não se associou com a presença de DAC (OR 0,94, IC 95% 0,59--...

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Obesity paradox in a cohort of 4880 consecutive patients undergoing percutaneous coronary intervention

Abstract: Among patients undergoing percutaneous intervention for coronary artery disease, increased BMI was associated with improved 5 year survival. Among those with established coronary disease, the adverse effects of excess adipose tissue may be offset by beneficial vasoactive properties.

Cited by 205 publications

References 24 publications

Body Composition and Coronary Heart Disease Mortality—An Obesity or a Lean Paradox?

Body Composition and Coronary Heart Disease Mortality—An Obesity or a Lean Paradox?

Does metabolic syndrome predict significant angiographic coronary artery disease?

Does metabolic syndrome predict significant angiographic coronary artery disease?

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