RT Journal Article
SR Electronic
T1 Moderate overweight is beneficial and severe obesity detrimental for patients with documented atherosclerotic heart disease
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 655
OP 660
DO 10.1136/heartjnl-2012-303066
VO 99
IS 9
A1 Azimi, Aziza
A1 Charlot, Mette Gitz
A1 Torp-Pedersen, Christian
A1 Gislason, Gunnar H
A1 Køber, Lars
A1 Jensen, Lisette Okkels
A1 Thayssen, Per
A1 Ravkilde, Jan
A1 Tilsted, Hans-Henrik
A1 Lassen, Jens Flensted
A1 Thuesen, Leif
YR 2013
UL http://heart.bmj.com/content/99/9/655.abstract
AB 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.