BMI and the mortality paradox in patients undergoing cardiovascular procedures-Causation or Association?

Abstract

Key Points There is limited evidence on the relationship between body mass index (BMI) and mortality risk in cardiac patients in the contemporary era of invasive cardiology. In the current observational analysis from the multicenter KARDIO registry (2012–18), BMI was non‐linearly associated with long‐term mortality. After multivariable adjustment, underweight (<18.5 kg/m2) and obesity class III (BMI >40 kg/m2) were associated with increased hazards of all‐cause mortality at a median follow‐up of 4.9 years. Clinicians should be vigilant about the obesity paradox in patients undergoing invasive cardiology procedures, and factor them in as they deliberate appropriateness and indications of the procedures.