Body mass index and cardiovascular outcomes in patients with acute coronary syndrome by diabetes status: the obesity paradox in a Korean national cohort study

Cardiovasc Diabetol. 2020 Nov 10;19(1):191. doi: 10.1186/s12933-020-01170-w.

Abstract

Background: The "obesity paradox" has not been elucidated in the long-term outcomes of acute coronary syndrome (ACS). We investigated the association between obesity and cardiovascular (CV) outcomes in ACS patients with and without diabetes.

Methods: We identified 6978 patients with ACS aged 40-79 years from the Korean National Health Insurance Service-Health Screening Cohort between 2002 and 2015. Baseline body mass index (BMI) was categorized as underweight (< 18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2), obese class I (25.0-29.9 kg/m2), and obese class II (≥ 30.0 kg/m2). The primary outcome was major adverse CV events (MACE)-CV death, myocardial infarction (MI), and stroke. The secondary outcomes were the individual components of MACE, hospitalization for heart failure (HHF), and all-cause death.

Results: After adjustment for confounding variables, compared to normal-weight patients without diabetes (reference group), obese class I patients with and without diabetes had a lower risk of MACE, but only significant in patients without diabetes (with diabetes: hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.78-1.14; without diabetes: HR 0.78, 95% CI 0.62-0.97). Obese class II patient with diabetes had a higher risk of MACE with no statistical significance (HR 1.14, 95% CI 0.82-1.59). Underweight patients with and without diabetes had a higher risk of MACE, but only significant in patients with diabetes (with diabetes: HR 1.79, 95% CI 1.24-2.58; without diabetes: HR 1.23, 95% CI 0.77-1.97).

Conclusion: In ACS patients, obesity had a protective effect on CV outcomes, especially in patients without diabetes.

Keywords: Acute coronary syndrome; Diabetes mellitus; Obesity; Obesity paradox.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / epidemiology*
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / therapy
  • Adult
  • Aged
  • Biomarkers / blood
  • Blood Glucose / metabolism
  • Body Mass Index*
  • Comorbidity
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / epidemiology*
  • Female
  • Heart Failure / epidemiology
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Life Style
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Obesity / diagnosis
  • Obesity / epidemiology*
  • Obesity / mortality
  • Prognosis
  • Protective Factors
  • Republic of Korea / epidemiology
  • Risk Assessment
  • Risk Factors
  • Stroke / epidemiology
  • Time Factors

Substances

  • Biomarkers
  • Blood Glucose
  • Hypoglycemic Agents