Central obesity and survival in subjects with coronary artery disease: A systematic review of the literature and collaborative analysis with individual subject data

Thais Coutinho, Kashish Goel, Daniel Corrêa De S, Charlotte Kragelund, Alka M. Kanaya, Marianne Zeller, Jong Seon Park, Lars Kober, Christian Torp-Pedersen, Yves Cottin, Luc Lorgis, Sang Hee Lee, Young Jo Kim, Randal Thomas, Vronique L. Roger, Virend K. Somers, Francisco Lopez-Jimenez

Research output: Contribution to journalArticle

216 Scopus citations

Abstract

Objectives: The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients. Background: The question of which measure of obesity better predicts survival in patients with CAD is controversial. Methods: We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months. Results: From 2,188 studies found, 6 met inclusion criteria. We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort. A variable called "central obesity" was created on the basis of tertiles of WHR or WC. Cox-proportional hazards were adjusted for age, sex, and confounders. The final sample consisted of 15,923 subjects. There were 5,696 deaths after a median follow-up of 2.3 (interquartile range 0.5 to 7.4) years. Central obesity was associated with mortality (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.58 to 1.83), whereas BMI was inversely associated with mortality (HR: 0.64, 95% CI: 0.59 to 0.69). Central obesity was also associated with higher mortality in the subset of subjects with normal BMI (HR: 1.70, 95% CI: 1.52 to 1.89) and BMI <30 kg/m 2 (HR: 1.93, 95% CI: 1.61 to 2.32). Conclusions: In subjects with CAD, including those with normal and high BMI, central obesity but not BMI is directly associated with mortality.

Original languageEnglish (US)
Pages (from-to)1877-1886
Number of pages10
JournalJournal of the American College of Cardiology
Volume57
Issue number19
DOIs
StatePublished - May 10 2011

Keywords

  • central obesity
  • coronary artery disease
  • mortality
  • waist circumference
  • waist-hip ratio

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Coutinho, T., Goel, K., Corrêa De S, D., Kragelund, C., Kanaya, A. M., Zeller, M., Park, J. S., Kober, L., Torp-Pedersen, C., Cottin, Y., Lorgis, L., Lee, S. H., Kim, Y. J., Thomas, R., Roger, V. L., Somers, V. K., & Lopez-Jimenez, F. (2011). Central obesity and survival in subjects with coronary artery disease: A systematic review of the literature and collaborative analysis with individual subject data. Journal of the American College of Cardiology, 57(19), 1877-1886. https://doi.org/10.1016/j.jacc.2010.11.058