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Association of body mass index with mortality and cardiovascular events for patients with coronary artery disease


The association between obesity and prognosis in patients with coronary artery disease ( CAD ) remains uncertain. Researchers undertook a meta-analysis for the effects of body mass index ( BMI ) on mortality and cardiovascular events in these patients.

Studies that provided risk estimates for mortality or cardiovascular events on the basis of BMI in patients with coronary artery disease were identified.
Summary estimates of relative risks were obtained for five BMI groups: underweight, normal-weight, overweight, obese and grade II/III obese.
Mortality was analysed separately as short-term ( less than 6 months ) and long-term ( greater than or equal to 6 months ).

Data from 89 studies with 1 300 794 patients were included. Mean follow-up of long-term estimates was 3.2 years.

Using normal-weight as the reference, underweight was associated with higher risk of short-term mortality ( 2.24 [ 1.85 to 2.72 ] ) and long-term mortality ( 1.70 [ 1.56 to 1.86 ] ), overweight and obesity were both associated with lower risk of short-term mortality ( 0.69 [ 0.64 to 0.75 ]; 0.68 [ 0.61 to 0.75 ] ) and long-term mortality ( 0.78 [ 0.74 to 0.82 ]; 0.79 [ 0.73 to 0.85 ] ), but the long-term benefit of obesity disappeared after 5 years of follow-up ( 0.99 [ 0.91 to 1.08 ] ).

Grade II/III obesity was associated with lower risk of mortality in the short term ( 0.76 [ 0.62 to 0.91 ] ) but higher risk after 5 years of follow-up ( 1.25 [ 1.14 to 1.38 ] ).

The similar J-shaped pattern was also seen for cardiovascular mortality and across different treatment strategies.
Meta-regression found an attenuation of the inverse association between BMI and risk of mortality over longer follow-up.

In conclusion, the data support a J-shaped relationship between mortality and body mass index in patients with coronary artery disease. ( Xagena )

Wang ZJ et al, Heart 2015;101:1631-1638

XagenaMedicine_2015



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