TY - JOUR
T1 - Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease
T2 - Role of "normal weight central obesity"
AU - Coutinho, Thais
AU - Goel, Kashish
AU - Corrêa De Sá, Daniel
AU - Carter, Rickey E.
AU - Hodge, David O.
AU - Kragelund, Charlotte
AU - Kanaya, Alka M.
AU - Zeller, Marianne
AU - Park, Jong Seon
AU - Kober, Lars
AU - Torp-Pedersen, Christian
AU - Cottin, Yves
AU - Lorgis, Luc
AU - Lee, Sang Hee
AU - Kim, Young Jo
AU - Thomas, Randal
AU - Roger, Véronique L.
AU - Somers, Virend K.
AU - Lopez-Jimenez, Francisco
N1 - Funding Information:
Dr. Kober is on the steering committee of ATHMOSPHERE (sponsored by Novartis) and on the steering committee of ELIXA (sponsored by sanofi-aventis). Dr. Torp-Pedersen is on the steering committee of SCOUT (sponsored by Abbott), has given paid lectures with Abbott, served on the advisory board for Neurosearch, and has received lecture honoraria and advisory honoraria from Abbott and Neurosearch. Dr. Thomas has received research grants from Marriott Family Program in Individualized Medicine , and from Stratis Health . Dr. Somers has received research grants from Select Research and Phillips Respironics Foundation , and is a consultant for ResMed, Cardiac Concepts, Johnson & Johnson, Apnex Medical, Sova, and Merck. Dr. Lopez-Jimenez has performed research partially sponsored by Select Research, to assess the clinical value to measure body volumes with a three-dimensional scanner. All other authors have reported they have no relationships relevant to the contents of this paper to disclose.
PY - 2013/2/5
Y1 - 2013/2/5
N2 - Objectives: This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based on a combination of body mass index (BMI) and measures of central obesity. Background: In CAD patients, mortality has been reported to vary inversely with BMI ("obesity paradox"). In contrast, central obesity is directly associated with mortality. Because of this bi-directional relationship, we hypothesized that CAD patients with normal BMI but with central obesity would have worse survival compared with subjects with other combinations of BMI and central adiposity. Methods: We included 15,547 participants with CAD who took part in 5 studies from 3 continents. Multivariate stratified Cox-proportional hazard models that adjusted for potential confounders were used to assess mortality risk according to different patterns of adiposity that combined BMI with measures of central obesity. Results: Mean age was 66 years; 55% were men. There were 4,699 deaths over a median follow-up of 4.7 years. Subjects with normal weight but central obesity had the worst long-term survival: a person with BMI of 22 kg/m2 and waist-to-hip ratio (WHR) of 0.98 had higher mortality than a person with similar BMI but WHR of 0.89 (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.05 to 1.17); than a person with BMI of 26 kg/m2 and WHR of 0.89 (HR: 1.20; 95% CI: 1.09 to 1.31), than in a person with BMI of 30 kg/m2 and WHR of 0.89 (HR: 1.61; 95% CI: 1.39 to 1.86), and than a person with BMI of 30 kg/m 2 and WHR of 0.98 (HR: 1.27; 95% CI: 1.18 to 1.39) (p < 0.0001 for all). Conclusions: In patients with CAD, normal weight with central obesity was associated with the highest risk of mortality.
AB - Objectives: This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based on a combination of body mass index (BMI) and measures of central obesity. Background: In CAD patients, mortality has been reported to vary inversely with BMI ("obesity paradox"). In contrast, central obesity is directly associated with mortality. Because of this bi-directional relationship, we hypothesized that CAD patients with normal BMI but with central obesity would have worse survival compared with subjects with other combinations of BMI and central adiposity. Methods: We included 15,547 participants with CAD who took part in 5 studies from 3 continents. Multivariate stratified Cox-proportional hazard models that adjusted for potential confounders were used to assess mortality risk according to different patterns of adiposity that combined BMI with measures of central obesity. Results: Mean age was 66 years; 55% were men. There were 4,699 deaths over a median follow-up of 4.7 years. Subjects with normal weight but central obesity had the worst long-term survival: a person with BMI of 22 kg/m2 and waist-to-hip ratio (WHR) of 0.98 had higher mortality than a person with similar BMI but WHR of 0.89 (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.05 to 1.17); than a person with BMI of 26 kg/m2 and WHR of 0.89 (HR: 1.20; 95% CI: 1.09 to 1.31), than in a person with BMI of 30 kg/m2 and WHR of 0.89 (HR: 1.61; 95% CI: 1.39 to 1.86), and than a person with BMI of 30 kg/m 2 and WHR of 0.98 (HR: 1.27; 95% CI: 1.18 to 1.39) (p < 0.0001 for all). Conclusions: In patients with CAD, normal weight with central obesity was associated with the highest risk of mortality.
KW - coronary artery disease
KW - mortality
KW - obesity
KW - waist circumference
KW - waist-to-hip ratio
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U2 - 10.1016/j.jacc.2012.10.035
DO - 10.1016/j.jacc.2012.10.035
M3 - Article
C2 - 23369419
AN - SCOPUS:84873832868
SN - 0735-1097
VL - 61
SP - 553
EP - 560
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 5
ER -