Association between adiposity and lean mass with long-term cardiovascular events in patients with coronary artery disease: No paradox

Jose R. Medina-Inojosa, Virend Somers, Randal J. Thomas, Nathalie Jean, Sarah M. Jenkins, Miguel Angel Gomez-Ibarra, Marta Supervia, Francisco Lopez-Jimenez

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background--Prognosis based on body fat percentage (BF%) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF% have a higher risk for major adverse cardiovascular events (MACEs) and that fat-free mass is associated with better prognosis. Methods and Results--We included 717 patients referred to cardiac rehabilitation after coronary artery disease events or procedures who underwent air displacement plethysmography to assess BF%; 75% were men, with a mean age 61.4±11.4 years and a mean body mass index of 30±5.4 kg/m2. Follow-up was performed using a record linkage system. Patients were classified in sex-specific quartiles of BF% and fat-free mass index. The composite outcome of MACEs included acute coronary syndromes, coronary revascularization, stroke, or death from any cause. After a median follow-up of 3.9 years, 201 patients had a MACE. After adjusting for covariates, body mass index was not associated with MACEs (P=0.12). However, the risk of MACEs for those in the highest BF% quartile was nearly double when compared with those in the lowest quartile (hazard ratio, 1.89; 95% confidence interval, 1.30-2.77; P=0.0008). In contrast, fat-free mass was inversely associated with MACEs. The risk of MACEs for those in the fourth fat-free mass quartile was lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.35-0.82; P=0.004), when compared with those in the first quartile. Conclusions--In patients with coronary artery disease, there is no obesity paradox when measuring BF% instead of body mass index. BF% is associated with a higher risk of MACEs, whereas fat-free mass is associated with a lower risk of MACEs. Body mass index was not associated with MACEs.

Original languageEnglish (US)
Article numbere007505
JournalJournal of the American Heart Association
Volume7
Issue number10
DOIs
StatePublished - May 15 2018

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Adiposity
Adipose Tissue
Coronary Artery Disease
Fats
Body Mass Index
Confidence Intervals
Plethysmography
Acute Coronary Syndrome
Cause of Death
Obesity
Stroke
Air

Keywords

  • Adipose tissue
  • Cardiac rehabilitation
  • Coronary artery disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association between adiposity and lean mass with long-term cardiovascular events in patients with coronary artery disease : No paradox. / Medina-Inojosa, Jose R.; Somers, Virend; Thomas, Randal J.; Jean, Nathalie; Jenkins, Sarah M.; Gomez-Ibarra, Miguel Angel; Supervia, Marta; Lopez-Jimenez, Francisco.

In: Journal of the American Heart Association, Vol. 7, No. 10, e007505, 15.05.2018.

Research output: Contribution to journalArticle

Medina-Inojosa, Jose R. ; Somers, Virend ; Thomas, Randal J. ; Jean, Nathalie ; Jenkins, Sarah M. ; Gomez-Ibarra, Miguel Angel ; Supervia, Marta ; Lopez-Jimenez, Francisco. / Association between adiposity and lean mass with long-term cardiovascular events in patients with coronary artery disease : No paradox. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 10.
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title = "Association between adiposity and lean mass with long-term cardiovascular events in patients with coronary artery disease: No paradox",
abstract = "Background--Prognosis based on body fat percentage (BF{\%}) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF{\%} have a higher risk for major adverse cardiovascular events (MACEs) and that fat-free mass is associated with better prognosis. Methods and Results--We included 717 patients referred to cardiac rehabilitation after coronary artery disease events or procedures who underwent air displacement plethysmography to assess BF{\%}; 75{\%} were men, with a mean age 61.4±11.4 years and a mean body mass index of 30±5.4 kg/m2. Follow-up was performed using a record linkage system. Patients were classified in sex-specific quartiles of BF{\%} and fat-free mass index. The composite outcome of MACEs included acute coronary syndromes, coronary revascularization, stroke, or death from any cause. After a median follow-up of 3.9 years, 201 patients had a MACE. After adjusting for covariates, body mass index was not associated with MACEs (P=0.12). However, the risk of MACEs for those in the highest BF{\%} quartile was nearly double when compared with those in the lowest quartile (hazard ratio, 1.89; 95{\%} confidence interval, 1.30-2.77; P=0.0008). In contrast, fat-free mass was inversely associated with MACEs. The risk of MACEs for those in the fourth fat-free mass quartile was lower (adjusted hazard ratio, 0.53; 95{\%} confidence interval, 0.35-0.82; P=0.004), when compared with those in the first quartile. Conclusions--In patients with coronary artery disease, there is no obesity paradox when measuring BF{\%} instead of body mass index. BF{\%} is associated with a higher risk of MACEs, whereas fat-free mass is associated with a lower risk of MACEs. Body mass index was not associated with MACEs.",
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T1 - Association between adiposity and lean mass with long-term cardiovascular events in patients with coronary artery disease

T2 - No paradox

AU - Medina-Inojosa, Jose R.

AU - Somers, Virend

AU - Thomas, Randal J.

AU - Jean, Nathalie

AU - Jenkins, Sarah M.

AU - Gomez-Ibarra, Miguel Angel

AU - Supervia, Marta

AU - Lopez-Jimenez, Francisco

PY - 2018/5/15

Y1 - 2018/5/15

N2 - Background--Prognosis based on body fat percentage (BF%) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF% have a higher risk for major adverse cardiovascular events (MACEs) and that fat-free mass is associated with better prognosis. Methods and Results--We included 717 patients referred to cardiac rehabilitation after coronary artery disease events or procedures who underwent air displacement plethysmography to assess BF%; 75% were men, with a mean age 61.4±11.4 years and a mean body mass index of 30±5.4 kg/m2. Follow-up was performed using a record linkage system. Patients were classified in sex-specific quartiles of BF% and fat-free mass index. The composite outcome of MACEs included acute coronary syndromes, coronary revascularization, stroke, or death from any cause. After a median follow-up of 3.9 years, 201 patients had a MACE. After adjusting for covariates, body mass index was not associated with MACEs (P=0.12). However, the risk of MACEs for those in the highest BF% quartile was nearly double when compared with those in the lowest quartile (hazard ratio, 1.89; 95% confidence interval, 1.30-2.77; P=0.0008). In contrast, fat-free mass was inversely associated with MACEs. The risk of MACEs for those in the fourth fat-free mass quartile was lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.35-0.82; P=0.004), when compared with those in the first quartile. Conclusions--In patients with coronary artery disease, there is no obesity paradox when measuring BF% instead of body mass index. BF% is associated with a higher risk of MACEs, whereas fat-free mass is associated with a lower risk of MACEs. Body mass index was not associated with MACEs.

AB - Background--Prognosis based on body fat percentage (BF%) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF% have a higher risk for major adverse cardiovascular events (MACEs) and that fat-free mass is associated with better prognosis. Methods and Results--We included 717 patients referred to cardiac rehabilitation after coronary artery disease events or procedures who underwent air displacement plethysmography to assess BF%; 75% were men, with a mean age 61.4±11.4 years and a mean body mass index of 30±5.4 kg/m2. Follow-up was performed using a record linkage system. Patients were classified in sex-specific quartiles of BF% and fat-free mass index. The composite outcome of MACEs included acute coronary syndromes, coronary revascularization, stroke, or death from any cause. After a median follow-up of 3.9 years, 201 patients had a MACE. After adjusting for covariates, body mass index was not associated with MACEs (P=0.12). However, the risk of MACEs for those in the highest BF% quartile was nearly double when compared with those in the lowest quartile (hazard ratio, 1.89; 95% confidence interval, 1.30-2.77; P=0.0008). In contrast, fat-free mass was inversely associated with MACEs. The risk of MACEs for those in the fourth fat-free mass quartile was lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.35-0.82; P=0.004), when compared with those in the first quartile. Conclusions--In patients with coronary artery disease, there is no obesity paradox when measuring BF% instead of body mass index. BF% is associated with a higher risk of MACEs, whereas fat-free mass is associated with a lower risk of MACEs. Body mass index was not associated with MACEs.

KW - Adipose tissue

KW - Cardiac rehabilitation

KW - Coronary artery disease

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