Abstract
BackgroundA number of previous studies have suggested that overweight or obese patients with coronary artery disease (CAD) may have lower morbidity and mortality than their leaner counterparts. Few studies have addressed possible gender differences, and the results are conflicting. We examined the association between body mass index (BMI) and risk of acute myocardial infarction (AMI), cardiovascular (CV) death and all-cause mortality in men and women with suspected stable angina pectoris.MethodThe cohort included 4164 patients with suspected stable angina undergoing elective coronary angiography between 2000 and 2004. Events were registered until the end of 2006. Hazard ratios (HR) (95% confidence intervals) were estimated using Cox regression by comparing normal weight (18.5-24.9 kg/m2) with overweight (25–29.9 kg/m2) and obese (≥30 kg/m2) patients. Underweight (<18.5 kg/m2) patients were excluded from the study.ResultsOf 4131 patients with complete data, 72% were males and 75% were diagnosed with significant CAD. The mean (standard deviation (SD)) age in the total population was 62 (10) years. Mean (SD) BMI was 26.8 (3.9) kg/m2, 34% was normal weight, 48% overweight and 19% obese. During follow up, a total of 337 (8.2%) experienced an AMI and 302 (7.3%) patients died, of whom 165 (4.0%) died from cardiovascular causes. We observed a significant interaction between BMI groups and gender with regards to risk of AMI (p = 0.011) and CV death (p = 0.031), but not to risk of all-cause mortality; obese men had a multivariate adjusted increased risk of AMI (HR 1.80 (1.28, 2.52)) and CV death (HR 1.60 (1.00, 2.55)) compared to normal weight men. By contrast, overweight women had a decreased risk of AMI (HR 0.56 (0.33, 0.98)) compared to normal weight women. The risk of all-cause mortality did not differ between BMI categories.ConclusionCompared with normal weight subjects, obese men had an increased risk of AMI and CV death, while overweight women had a decreased risk of AMI. These findings may potentially explain some of the result variation in previous studies reporting on the obesity paradox.Trial registrationClinicaltrials.gov Identifier: NCT00354081
Highlights
A number of previous studies have suggested that overweight or obese patients with coronary artery disease (CAD) may have lower morbidity and mortality than their leaner counterparts
We observed a significant interaction between body mass index (BMI) groups and gender with regards to risk of acute myocardial infarction (AMI) (p = 0.011) and CV death (p = 0.031), but not to risk of all-cause mortality; obese men had a multivariate adjusted increased risk of AMI (HR 1.80 (1.28, 2.52)) and CV death (HR 1.60 (1.00, 2.55)) compared to normal weight men
Despite the fact that both body fat percentage and distribution vary by gender [4], only a limited number of studies among patients with CAD or suspected CAD have examined the association between BMI and risk of coronary events and mortality in men and women separately, and the reported results are conflicting [5,6,7,8,9]
Summary
A number of previous studies have suggested that overweight or obese patients with coronary artery disease (CAD) may have lower morbidity and mortality than their leaner counterparts. We examined the association between body mass index (BMI) and risk of acute myocardial infarction (AMI), cardiovascular (CV) death and all-cause mortality in men and women with suspected stable angina pectoris. Some studies of patients with coronary artery disease (CAD) suggest that being overweight or obese has beneficial effects in terms of reduced risk of CV events and/or mortality; a phenomenon known as the obesity paradox. Despite the fact that both body fat percentage and distribution vary by gender [4], only a limited number of studies among patients with CAD or suspected CAD have examined the association between BMI and risk of coronary events and mortality in men and women separately, and the reported results are conflicting [5,6,7,8,9]. There is, a tendency towards a non-disadvantageous [5,6,9] or even a beneficial [7] effect of overweight and obesity among women, while obesity appears to increase the risk of coronary events in men [5,6]
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