Abstract
In patients with coronary artery disease (CAD), obesity is paradoxically associated with better survival (the 'obesity paradox'). Our objective was to determine whether this counterintuitive relationship extends to health-related quality of life (HRQOL) outcomes. Cross-sectional observational study. All adults undergoing coronary angiography residing in Alberta, Canada between January 2003 and March 2006 in the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry. Patients completed self-reported questionnaires 1 year after their index cardiac catheterization, including the Seattle Angina Questionnaire (SAQ) and the EuroQol 5D (EQ-5D Index). Patients were grouped into six body mass index (BMI) categories (underweight, normal, overweight, mild obesity, moderate obesity and severe obesity). An analysis of covariance was used to create risk-adjusted scores. A total of 5362 patients were included in the analysis. Obese patients were younger than normal and overweight participants, and had a higher prevalence of depression and cardiovascular risk factors. In the adjusted models, SAQ physical function scores and the EQ Index (representing overall QOL) were significantly reduced in patients with mild, moderate and severe obesity compared with patients with a normal BMI. Patients with severe obesity had both statistically and clinically significant reductions in HRQOL scores. Depressive symptoms accounted for a large proportion in variability of all HRQOL scores. BMI is inversely associated with physical function and overall HRQOL in CAD patients, especially in patients with severe obesity. High body weight is a modifiable risk factor; however, given the apparent obesity paradox in patients with CAD, it is critical that future studies be conducted to fully clarify the relationships between HRQOL and body composition (body fat and lean mass), nutritional state and survival outcomes.
Highlights
We have shown that body mass index (BMI) is inversely associated with physical function and overall health-related quality of life (HRQOL) in coronary artery disease (CAD) patients, especially in patients with severe obesity
High body weight is a modifiable risk factor, and proper weight management could potentially improve the HRQOL of patients with obesity
Given the apparent obesity paradox in patients with CAD, it is critical that future studies be conducted to investigate the relationships between HRQOL and body composition, nutritional state and survival outcomes so that appropriate interventions can be developed
Summary
Two recent meta-analyses in the coronary artery disease (CAD) population have reported counterintuitive associations between obesity and clinical outcomes.[1,2] studies have shown that being overweight or obese (body mass index (BMI) of X25 kg m–2) is associated with greaterThe previous literature in health-related quality of life (HRQOL) and obesity in CAD is limited to intervention studies, analyzing the effect of weight loss from cardiac rehabilitation on HRQOL.[5,6,7,8] it has been observed that cardiac rehabilitation is associated with positive changes in HRQOL,[7] previous studies have not separated patients by different degrees of obesity, nor have they compared HRQOL or changes in HRQOL between obese and non-obese subjects. Two recent meta-analyses in the coronary artery disease (CAD) population have reported counterintuitive associations between obesity and clinical outcomes.[1,2] studies have shown that being overweight or obese (body mass index (BMI) of X25 kg m–2) is associated with greater. SAQ physical function scores and the EQ Index (representing overall QOL) were significantly reduced in patients with mild, moderate and severe obesity compared with patients with a normal BMI. High body weight is a modifiable risk factor; given the apparent obesity paradox in patients with CAD, it is critical that future studies be conducted to fully clarify the relationships between HRQOL and body composition (body fat and lean mass), nutritional state and survival outcomes. International Journal of Obesity (2010) 34, 1434–1441; doi:10.1038/ijo.2010.73; published online 13 April 2010
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