Relation of Body Mass Index to Outcome in Patients With Known or Suspected Coronary Artery Disease

Galal, Wael; Domburg, Ron T. van; Feringa, Harm H.H.; Schouten, Olaf; Elhendy, Abdou; Bax, Jeroen J.; Awara, Adel M.M.; Klein, Jan; Poldermans, Don

doi:10.1016/j.amjcard.2007.01.018

Cited by 48 publications

(35 citation statements)

References 18 publications

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“…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. However, when the authors adjusted for the presence of chronic obstructive pulmonary disease, the inverse relationship was lost.…”

Section: Discussionmentioning

confidence: 96%

“…[5][6][7][8][9] Furthermore, it is not clear what measure of adiposity best predicts the occurrence of cardiovascular events, 10,11 and controversy exists about and the impact of body fat distribution on outcome. 3,4,9 In the Physician's Heath Study, 3 Gelber et al observed that cardiovascular risk increased linearly and significantly with higher levels of all adiposity indices, that is, body mass index (BMI), waist circumference (WC), waist-to-hip ratio and waist-to-height ratio.…”

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: 96%

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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“…Patients with ASO were more likely to have a lower BMI, although normal BMI was noted in both ASO and nonatherosclerotic patients. This finding is likely due to the obesity paradox, 8,9) which suggests that low BMI is partially mediated by malnutrition and systemic inflammation due to PAD. 10) The serum EPA/AA ratio was significantly reduced in ASO patients without DM compared to patients with non-atherosclerotic disease, suggesting an association between EPA/AA ratio and ASO.…”

Section: Discussionmentioning

confidence: 85%

Relationship between Arteriosclerosis Obliterans and the Ratio of Serum Eicosapentaenoic Acid to Arachidonic Acid

Fukuda

Fujioka

Hosaka

et al. 2014

ATCS

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“…In a retrospective study of 5,950 men and women with known or suspected coronary artery disease Galal et al 52 reported that the hazard ratio (HR) for cardiac death or death from acute MI in underweight patients (BMI  18.5 kg/m 2 ) was more than double that for subjects in the normal BMI range (18.5-24.9 kg/m 2 ). In comparison, overweight (BMI 25-29.9 kg/m 2 ) and obese (BMI  30 kg/m 2 ) subjects had a lower HR for cardiac death compared with subjects in the normal BMI range (following multivariate adjustment).…”

Section: Cardiovascular Diseasementioning

confidence: 99%

The Impact of Obesity on Adverse Cardiovascular Outcomes in the General Population and in patients with Type 2 Diabetes

Palmer¹,

Kalsekar

Boye

et al. 2009

Clinical medicine. Endocrinology and diabetes

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Objectives: There is an established causal link between obesity and cardiovascular outcomes. The aim of this review was to determine whether an independent relationship exists between anthropometric measurements of weight (typically body mass index [BMI]) and cardiovascular outcomes (e.g. angina, myocardial infarction, congestive heart failure, stroke, and mortality due to cardiovascular disease) in the general population and in patients with type 2 diabetes.Methods: A review of the medical literature published between 1988 and May 2008 was conducted using the PubMed, EMBASE, Cochrane and Center for Review and Dissemination databases. Studies longer than 12 months, with 500 adult subjects and published in English were included.Results: In studies conducted in general populations there was an overall trend towards increased risk for adverse cardiovascular outcomes with increasing BMI. The nature and strength of this relationship varied according to the measurement used (e.g. BMI, waist circumference, waist-to-hip ratio) and the population studied, with notable differences observed in Asian/Asia-Pacific compared with European or North American-based studies. However, data from diabetes-specific populations are limited. Conclusions:In general, the degree of being overweight or obese was associated with an elevated risk of adverse cardiovascular events and mortality. Although inextricable links exist between obesity, type 2 diabetes and cardiovascular disease in the general population, the extent to which findings can be extrapolated to a diabetes-specific population is limited.

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Relation of Body Mass Index to Outcome in Patients With Known or Suspected Coronary Artery Disease

Cited by 48 publications

References 18 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

Relationship between Arteriosclerosis Obliterans and the Ratio of Serum Eicosapentaenoic Acid to Arachidonic Acid

The Impact of Obesity on Adverse Cardiovascular Outcomes in the General Population and in patients with Type 2 Diabetes

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