Association of body mass index with mortality and cardiovascular events for patients with coronary artery disease: a systematic review and meta-analysis

Wang, Zhi Jian; Zhou, Yu Jie; Galper, Benjamin Z.; Gao, Fei; Yeh, Robert W.; Mauri, Laura

doi:10.1136/heartjnl-2014-307119

Cited by 180 publications

(120 citation statements)

References 26 publications

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“…129 Many studies have also demonstrated a strong obesity paradox among patients with CHD. 9,120,121,130 A recent metaanalysis of 89 studies in >1.3 million patients with CHD, by far the largest of such studies, by Wang et al 131 confirmed information from previous meta-analyses and provided important information about short-term versus long-term prognosis and regarding obesity severity. In their analysis, the obesity paradox was more evident during early follow-up and seemed to disappear after 5 years.…”

Section: Obesity Paradox In Patients With Cvdmentioning

confidence: 56%

Obesity and Cardiovascular Disease

Ortega

Lavie

Blair

2016

Circulation Research

926

603

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T here is overall agreement in the scientific and clinical community that obesity is one of the major public health problems of this century. The first documented reports on obesity date from the end of the 19th century and the beginning of the 20th century.1-3 From these days to date, >57 000 articles have been published in PubMed including the term obesity in the title, with these figures being 3× larger when searching by obesity also in the abstract. Figure 1 graphically Abstract: The prevalence of obesity has increased worldwide over the past few decades. In 2013, the prevalence of obesity exceeded the 50% of the adult population in some countries from Oceania, North Africa, and Middle East. Lower but still alarmingly high prevalence was observed in North America (≈30%) and in Western Europe (≈20%). These figures are of serious concern because of the strong link between obesity and disease. In the present review, we summarize the current evidence on the relationship of obesity with cardiovascular disease (CVD), discussing how both the degree and the duration of obesity affect CVD. Although in the general population, obesity and, especially, severe obesity are consistently and strongly related with higher risk of CVD incidence and mortality, the one-sizefits-all approach should not be used with obesity. There are relevant factors largely affecting the CVD prognosis of obese individuals. In this context, we thoroughly discuss important concepts such as the fat-but-fit paradigm, the metabolically healthy but obese (MHO) phenotype and the obesity paradox in patients with CVD. About the MHO phenotype and its CVD prognosis, available data have provided mixed findings, what could be partially because of the adjustment or not for key confounders such as cardiorespiratory fitness, and to the lack of consensus on the MHO definition. In the present review, we propose a scientifically based harmonized definition of MHO, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis. (Circ Res.

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Section: Obesity Paradox In Patients With Cvdmentioning

confidence: 56%

Obesity and Cardiovascular Disease

Ortega

Lavie

Blair

2016

Circulation Research

926

603

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“…21 Indeed, an "obesity paradox" regarding both CV and all-cause death has been described for hypertension, CHD, congestive heart failure, and peripheral arterial disease. 2,22,23 Our data show that overweight and obese patients with AF have a lower risk for stroke, but no significant impact of obesity on major bleeding or MI was seen. For the outcome of all-cause death, our data suggest that the influence of BMI categories on was attenuated by good anticoagulation control and creatinine clearance, the latter being significantly associated with mortality in patients with AF.…”

Section: Discussionmentioning

confidence: 86%

“…A 2-sided p value <0.05 was considered statistically significant. All analyses were performed using SPSS v. 22.0 (IBM, New York).…”

Section: Methodsmentioning

confidence: 99%

Relation of Nonvalvular Atrial Fibrillation to Body Mass Index (from the SPORTIF Trials)

Proietti

Lane

Lip

2016

The American Journal of Cardiology

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Obesity is well-established as a major cardiovascular (CV) risk factor. Obesity confers a greater risk for developing atrial fibrillation (AF), but the relation between obesity and established nonvalvular AF for stroke and all-cause death is still unclear. To ascertain the prevalence of overweight and obesity in patients with nonvalvular AF, their influence on adverse events, and the relation with anticoagulation control, we performed this post hoc analysis of the pooled Stroke Prevention using an Oral Thrombin Inhibitor in patients with atrial Fibrillation (SPORTIF) III and V data sets. For this study, we analyzed all patients assigned to the warfarin arm with data on body mass index (BMI). Time in therapeutic range was used as an index of the quality of anticoagulation control. The 3,630 patients eligible for this analysis were categorized as follows: (1) BMI 18.5 to 24.9 ("normal weight") in 24.1%; (2) BMI 25.0 to 29.9 ("overweight") in 39.8%; and BMI ≥30 ("obese") in 36.1%. Both overweight (hazard ratio [HR] 0.70) and obese (HR 0.59) categories were inversely associated with the composite outcome of stroke/all-cause death. A similar inverse association was seen for the end point of stroke (HR 0.61 and 0.47, respectively). Good anticoagulation control also attenuated the association between BMI categories and outcomes. In patients with time in therapeutic range >70%, BMI category was not significantly associated with the composite outcome of stroke/death and stroke. Stroke and all-cause death progressively reduced in overweight and obese anticoagulated patients with AF. The inverse relation of BMI categories to the risk of stroke and all-cause death was mitigated by good anticoagulation control.

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“…Concomitant comorbidities in these subgroups may, in part, account for the attenuation of the effect of abdominal obesity on incident AF from these factors in the present study. Previous studies have observed that overweight status, obesity, and high WC may be associated with favorable prognosis—referred to as the “obesity paradox”—in patients with cardiovascular disease 43, 44, 45, 46, 47. In populations with severe comorbidities (heart failure, renal disease), obesity may also have protective effects against AF (the obesity paradox).…”

Section: Discussionmentioning

confidence: 99%

Associations of Abdominal Obesity and New‐Onset Atrial Fibrillation in the General Population

Baek

Yang

Kim

et al. 2017

JAHA

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BackgroundHigher height and weight are known to be associated with higher risk of atrial fibrillation (AF); however, whether the risk of AF is related to abdominal obesity is unclear.Methods and ResultsWe studied 501 690 adults (mean age: 47.6±14.3 years; 250 664 women [50.0%]) without baseline AF in the National Sample Cohort released by the National Health Insurance Service in Korea. Body mass index (underweight defined as <18.5; normal, 18.5 to <25.0; overweight, 25.0 to <30.0; and obese, ≥30.0) and waist circumference (abdominal obesity defined as ≥90 cm for men and ≥80 cm for women) were evaluated. During a mean follow‐up of 3.9±1.3 years, 3443 participants (1432 women [41.6%]) developed AF. In multivariable models adjusted for clinical variables, the AF risk of underweight, overweight, and obese individuals increased by 21% (95% confidence interval, 1.01–1.45, P=0.043), 14% (95% confidence interval, 1.06–1.23, P<0.001), and 52% (95% confidence interval, 1.30–1.78, P<0.001), respectively, compared with those with normal body mass index. AF risk with confounder‐adjusted hazards for abdominal obesity was 18% (95% confidence interval, 1.10–1.27, P<0.001). The increased AF risk was present in abdominally obese individuals regardless of body mass index except for the obese group. In subgroup analysis, abdominal obesity by waist circumference conferred increased risk of new‐onset AF, particularly in participants without comorbidities.ConclusionsAbdominal obesity is an important, potentially modifiable risk factor for AF in nonobese Asian persons. These data suggest that interventions to decrease abdominal obesity may reduce the population burden of AF.

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Association of body mass index with mortality and cardiovascular events for patients with coronary artery disease: a systematic review and meta-analysis

Abstract: Our data support a J-shaped relationship between mortality and BMI in patients with CAD. The limitation of current literature warrants better design of future studies.

Cited by 180 publications

References 26 publications

Obesity and Cardiovascular Disease

Obesity and Cardiovascular Disease

Relation of Nonvalvular Atrial Fibrillation to Body Mass Index (from the SPORTIF Trials)

Associations of Abdominal Obesity and New‐Onset Atrial Fibrillation in the General Population

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