Guideline Recommended Medical Therapy for Cardiovascular Diseases in the Obese: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program

Abstract

BackgroundStigma against the obese is well described in health care and may contribute to disparities in medical decision‐making. It is unknown whether similar disparity exists for obese patients in cardiovascular care. We evaluated the association between body mass index (BMI) and prescription of guideline‐recommended medications in patients undergoing elective percutaneous coronary intervention.Methods and ResultsUsing data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking System Program, we identified patients undergoing elective percutaneous coronary intervention from 2007 to 2012, stratifying them by category of BMI. We described rates of prescription for class I guideline recommended medications for each BMI category (normal, overweight, and obese). Multivariable logistic regression assessed the association between BMI category and medication prescription. Seventeen thousand thirty‐seven patients were identified, with 35.3% having overweight BMI, and 50.8% obese BMI. Obese patients were more likely than normal BMI patients to be prescribed β‐blockers (OR 1.34), statins (OR 1.39), or ACE/ARB (odds ratio [OR] 1.52; all significant) when indicated. Overweight patients were more likely than normal BMI patients to be prescribed statins (OR 1.29) and angiotensin‐converting enzymes/angiotensin II receptor blockers (OR 1.41) when indicated. There was no association between BMI category and prescription of anticoagulants.ConclusionsOver 85% of patients undergoing elective percutaneous coronary intervention in the Veterans Affairs are overweight or obese. Rates of guideline‐indicated medication prescription were <70% among all patients, and across BMI categories, with an association between increased BMI and greater use of guideline‐recommended medications. Our findings offer a possible contribution to the obesity paradox seen in many cardiovascular conditions.

Does the “obesity paradox” really exist in lung cancer surgery? —maybe we should recognize what is the “obesity” first

“…Dr. Flegal thinks that the "obesity paradox" terminology is essentially a rhetorical device in which the researchers collect a range of current studies together and further identify a unitary phenomenon showing an unexpected benefit of clinically diagnosed obesity (BMI ≥30 kg/m 2 ). Such findings can be easily influenced by a variety of confounding factors that may differ across diseases and treatments, and are not necessarily mutually exclusive, such as the selection bias from the retrospective nature (11), undetected cachexia (12), weight loss induced by chronic wasting diseases before surgery (13), and lower likelihood of receiving guidelinerecommended treatments (14). The "obesity paradox" terminology oversimplifies a complex of underlying pathophysiological mechanisms.…”

The Obesity Paradox: A Misleading Term That Should Be Abandoned

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Mental illness and obesity among Veterans undergoing percutaneous coronary intervention: Insights from the VA CART program

“…Estimates vary, but between 20% and 40% of Veterans have a psychiatric diagnosis and nearly 80% are living with overweight or obesity . Furthermore, Veterans are at a significantly higher risk of developing CVD than non‐Veterans, and over half of Veterans undergoing PCI have obesity . The Veterans Affairs (VA) Clinical Assessment Reporting and Tracking (CART) program currently collects clinical and procedural data on Veterans undergoing coronary angiography and PCI across VA cardiac catheterization laboratories.…”