Heart doi:10.1136/heartjnl-2012-303066
  • Valvular heart disease

Moderate overweight is beneficial and severe obesity detrimental for patients with documented atherosclerotic heart disease

  1. Leif Thuesen5
  1. 1Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
  2. 2Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  3. 3Department of Cardiology, Odense University Hospital, University of southern Denmark, Denmark
  4. 4Department of Cardiology, Aarhus University Hospital Aalborg, Aalborg, Denmark
  5. 5Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
  1. Correspondence to Aziza Azimi, Department of Cardiology, Gentofte Hospital, post 635, Niels Andersens Vej 65, Hellerup 2900, Denmark; Aziza.Azimi{at}
  • Received 18 September 2012
  • Revised 28 November 2012
  • Accepted 10 December 2012
  • Published Online First 18 January 2013


Objective Obesity is paradoxically associated with enhanced survival in patients with established cardiovascular disease. We explored this paradox further by examining the influence of obesity on survival in patients with verified atherosclerotic heart disease.

Design and patients This retrospective registry based cohort study included all patients from the Western Denmark Heart Registry with coronary atherosclerosis confirmed by coronary angiography from January 2000 to December 2010. Patients were divided into eight groups according to body mass index (BMI) based on WHO BMI classification.

Setting Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.

Results The study included 37 573 patients (70.7% men) with a mean age of (66.3±11.1) years. During the 11 years of follow-up, 5866 (15.6%) patients died. Multivariable analysis confirmed that the risk of death was the lowest among the preobese patients (27.5≤BMI<30 kg/m2) with adjusted HR of 0.82 (95% CI 0.71 to 0.95; p=0.008) and increased with both low (BMI<18.50 kg/m2) and very high (BMI≥40 kg/m2) BMI, HR 2.04 (95% CI 1.63 to 2.57; p<0.001) and HR 1.35 (95% CI 1.05 to 1.72; p<0.01), respectively. Also the normal weight class I (18.5≤BMI<23 kg/m2) had a significant risk of mortality HR 1.28 (95% CI 1.13 to 1.45; p<0.001). Obese classes I and II did not differ from the reference group (23≤BMI<25 kg/m2).

Conclusions Overweight atherosclerotic heart disease patients have improved survival compared with normal weight patients. Underweight and severely obese patients have increased mortality. Our results lean more towards an overweight paradox than an obesity paradox.

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