Abstract 4206: Invasive Treatments for Obese Patients with CAD: An Explanation for the “Obesity Paradox”? Analysis of 130,139 Hospitalizations in Get With The Guidelines

Abstract

BACKGROUND : Obesity is a well documented risk factor for cardiovascular disease and long-term mortality, yet a previous analysis of the Get With The Guidelines (GWTG) database revealed a paradoxically lower short-term mortality rates in patients with coronary artery disease (CAD). We hypothesized that this surprising trend may be the result of more aggressive management of such patients. METHODS : The GWTG database was analyzed for CAD hospitalizations from 1/00 to 12/05 with documented height and weight. Patients were divided into BMI (kg/m 2 ) categories: underweight (< 18.5), healthy weight (18.5 − 24.9) overweight (25.0 − 29.9), and obese (≥ 30). Reperfusion therapies, as well as baseline characteristics, medications, and in-hospital mortality by BMI category were assessed. RESULTS : There were 130,139 hospitalizations from 409 US hospitals analyzed. Patients in the overweight or obese BMI categories were younger, with more obesity-related risk factors for cardiovascular disease. In-hospital mortality was 5.4% in normal weight patients and 3.1% and 2.4% in the overweight and obese categories, respectively. In unadjusted analyses, a higher percentage of obese and overweight patients received indicated, guideline-recommended therapies (see Table ). After adjusting for common confounders, overweight and obese patients were more likely to undergo cardiac catheterization (p<0.01 for both, compared to normal) and PCI (p<0.0001 for overweight and obese vs. normal), as well as CABG surgery (p<0.0001 for both). They also had a significantly shorter length of hospitalization in the multivariate model (p<0.0001). CONCLUSIONS : While obesity remains a significant risk factor for the development of CAD, increased body mass does not in of itself represent a barrier to the use of invasive therapies for CAD. It may positively influence clinicians’ use of proven and intensive treatment strategies, contributing to better short-come outcomes in these patients.