Relation of Body Mass Index to Outcomes in Acute Coronary Syndrome
Section snippets
Background
Body mass index (BMI) is a commonly used metric used to determine whether patients are in a "healthy" range; with the extremes of BMI (underweight and overweight patients) both considered to have poorer overall outcomes. Obesity is becoming increasingly prevalent1; In Australia, 67% of the adult population were overweight (35.6%) or obese (31.3%).2 Obesity is a cardiovascular risk factor which predicts coronary artery disease, heart failure, and premature death.3, 4, 5, 6 However, in those with
Methods
We performed a retrospective analysis of the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE) and the Australian cohort of the Global Registry of Acute Coronary Events (GRACE Australia), both have been described previously.16,17 Both databases are multicentre, prospective, national, electronic cohort registries that aim to provide information on patients with ACS throughout Australia.16,17 The registries were conducted at 52
Results
8503 patients were identified, mean age 64 ± 15, the majority were male (72%). The number of patients in each category were: underweight- 95, healthy- 2,140, overweight- 3,258, obese- 2,653, and extremely obese- 375. Underweight patients were older (69.3 ±15 vs 66.9±13), more likely to be female (61% vs 32%) and had a higher prevalence of anemia, peripheral vascular disease, and previous cardiac failure than healthy patients (all p<0.05). Obese were younger (62.2 ±13 vs 66.9±13), with a higher
Discussion
There are conflicting data on the association between obesity and being underweight on outcomes in those with established ACS. This retrospective, multicentre, observational study, spanning a 20-year period, is the largest on this subject in a contemporary Australian population. Our study shows the persistence of the obesity paradox for in-hospital cardiovascular and all-cause mortality, and the presence of a U shaped relationship between outcomes and increasing BMI at 6 months, where patients
Authors contribution
Seshika Ratwatte writing – conceptualisation, methodology, writing original draft, review and editing, Karice Hyun – methodology, formal analysis, writing – review and editing, Mario D'Souza - methodology, formal analysis, Jennifer Barraclough – conceptualisation, writing – review and editing, Derek P. Chew writing – review and editing, Pratap Shetty writing – review and editing,Sanjay Patel writing – review and editing, David Amos writing – review and editing, and David Brieger –
References (31)
- et al.
Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study
Lancet (London, England)
(2005) - et al.
The relationship of body mass index to percutaneous coronary intervention outcomes
JACC Cardiovasc Interv
(2017) - et al.
Relation of body mass index to mortality among men with coronary heart disease
Am J Cardiol
(2010) - et al.
No evidence of “obesity Paradox” after treatment with drug-eluting stents in a routine clinical practice: results from the prospective Multicenter German DES. DE (German Drug-Eluting Stent) registry
JACC: Cardiovasc Interv
(2012) - et al.
Body mass index and the risk of infection – from under- weight to obesity
Clin Microbiol
(2018) - et al.
Impact of body mass index on long-term outcomes in Japanese patients following percutaneous coronary intervention: the Juntendo PCI Registry
J Cardiol
(2018) - et al.
The design and rationale of the Australian cooperative National Registry of acute coronary care, guideline adherence and clinical events (CONCORDANCE)
Heart Lung Circ
(2013) - et al.
Impact of body mass index on the five-year outcome of patients having percutaneous coronary interventions with drug-eluting stents
Am J Cardiol
(2011) - et al.
Medical therapies and invasive treatments for coronary artery disease by body mass: the "obesity paradox" in the Get With The Guidelines database
Am J Cardiol
(2007) - et al.
Is there an obesity paradox after percutaneous coronary intervention in the contemporary era? An analysis from a multicenter Australian registry
JACC: Cardiovasc Interv
(2010)
The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative
Am Heart J
Body-mass index and mortality in a prospective cohort of US adults
N Engl J Med
Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old
N Engl J Med
Cited by (13)
The obesity paradox in patients with acute coronary syndromes over 2 decades - the ACSIS registry 2000-2018
2023, International Journal of CardiologyObesity and Aging
2023, Endocrinology and Metabolism Clinics of North AmericaObesity survival paradox in patients hospitalized with community-acquired pneumonia. Assessing sex-differences in a population-based cohort study
2022, European Journal of Internal MedicineCitation Excerpt :Furthermore, lifestyle measures are applied to a greater extent in the obese patients [37]. Thus early, and more aggressive management of both medical and lifestyle related cardiovascular risk factors may lead to improved outcomes despite obesity [38]. In the present study, morbidly obese patients had a longer stay than obese and non-obese patients.
Impact of Low Body Mass Index on Features of Coronary Culprit Plaques and Outcomes in Patients With Acute Coronary Syndrome
2021, American Journal of CardiologyCitation Excerpt :In the present study, we focused on BMI in patients with ACS. Similar to several previous studies, our current study found that underweight patients were less likely to have diabetes, dyslipidemia, or hypertension.6,8,18–23 Although obese patients exhibit more metabolic cardiovascular risk factors and obesity itself is considered a risk factor for developing atherosclerosis,24 several clinical studies have shown that among patients with established coronary artery disease, cardiovascular mortality is higher in those who are underweight than in those who are overweight or obese.7,8,18–22
The CONCORDANCE registry has been funded by grants to the Sydney Local Health District from Sanofi Aventis, Astra Zeneca, Eli Lilly, Boehringer Ingelheim, the Merck Sharp and Dohme/Schering Plough joint venture, and the National Heart Foundation of Australia. The sponsors played no role in the design, analysis, or preparation of this study.
- ⁎⁎
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.