Impact of body mass index on short-term outcome after acute myocardial infarction: Does excess body weight have a paradoxical protective role?

Nicoletti, Ilaria; Cicoira, Mariantonietta; Morando, Giorgio; Benazzi, Chiara; Prati, Daniele; Morani, Giovanni; Rossi, Andrea; Zardini, Piero; Vassanelli, Corrado

doi:10.1016/j.ijcard.2005.04.005

Cited by 17 publications

(7 citation statements)

References 22 publications

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“…This protector effect of physical exercise may be justified by a greater development of collateral circulation, which is currently one of the therapeutic recommendations in these patients. The protector effect of obesity and overweight independent of physical exercise and other risk factors may be surprising, but a better prognosis has also been described in patients with obesity in heath failure and a lower incidence of acute myocardial infarction [39,40]. However, we did not find any relationship with waist circumference, although on adjusting for the body mass index (BMI) we did find a relationship with the second [OR 1.25 (0.87-1.81)] and the third tertile [OR 1.56 (1.02-2.37)] compared to the first tertile, which disappeared on adjustment for the remaining variables in the multivariate model.…”

Section: Discussionmentioning

confidence: 99%

The Peripheral Arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population

et al. 2010

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BackgroundThe early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease). The aim of the study is to know the prevalence and associated risk factors of peripheral arterial disease in the general population.MethodsWe performed a cross-sectional, multicentre, population-based study in 3786 individuals >49 years, randomly selected in 28 primary care centres in Barcelona (Spain). Peripheral arterial disease was evaluated using the ankle-arm index. Values < 0.9 were considered as peripheral arterial disease.ResultsThe prevalence (95% confidence interval) of peripheral arterial disease was 7.6% (6.7-8.4), (males 10.2% (9.2-11.2), females 5.3% (4.6-6.0); p < 0.001).Multivariate analysis showed the following risk factors: male sex [odds ratio (OR) 1.62; 95% confidence interval 1.01-2.59]; age OR 2.00 per 10 years (1.64-2.44); inability to perform physical activity [OR 1.77 (1.17-2.68) for mild limitation to OR 7.08 (2.61-19.16) for breathless performing any activity]; smoking [OR 2.19 (1.34-3.58) for former smokers and OR 3.83 (2.23-6.58) for current smokers]; hypertension OR 1.85 (1.29-2.65); diabetes OR 2.01 (1.42-2.83); previous cardiovascular disease OR 2.19 (1.52-3.15); hypercholesterolemia OR 1.55 (1.11-2.18); hypertriglyceridemia OR 1.55 (1.10-2.19). Body mass index ≥25 Kg/m2 OR 0.57 (0.38-0.87) and walking >7 hours/week OR 0.67 (0.49-0.94) were found as protector factors.ConclusionsThe prevalence of peripheral arterial disease is low, higher in males and increases with age in both sexes. In addition to previously described risk factors we found a protector effect in physical exercise and overweight.

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Section: Discussionmentioning

confidence: 99%

The Peripheral Arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population

et al. 2010

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“…Elevated BMI has been associated with decreased mortality through the preservation of fat-free mass. 20 Nicoletti et al 21 suggested that the neurohormonal system might protect the overweight individual against the catabolic effects of some diseases. Low fat-free mass itself has been associated with mortality as described by Allison et al and Heitmann et al 22,23 Fat-free mass was not measured in the present study, but it is reasonable to assume that these very elderly patients had low fat-free mass.…”

Section: Discussionmentioning

confidence: 99%

Body Mass Index is Inversely Related to Mortality in Elderly Subjects

et al. 2007

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PURPOSE:To study the long-term effect of being overweight on mortality in very elderly subjects. METHODS:The medical records of 470 inpatients (226 males) with a mean age of 81.5±7 years and hospitalized in an acute geriatric ward between 1999 and 2000 were reviewed for this study. Body mass index (BMI) at admission day was subdivided into quartiles: <22, 22-25, 25.01-28, and ≥28 kg/m 2 . Patients were followed-up until August 31, 2004. Mortality data were taken from death certificates.RESULTS: During a mean follow-up of 3.46±1.87 years (median 4.2 years [range 1.6 to 5.34 years]), 248 patients died. Those who died had lower baseline BMI than those who survived (24.1±4.2 vs 26.3±4.6 kg/m 2 ; p<.0001). The age-adjusted mortality rate decreased from 24 to 9.6 per 100 patient-years from the highest to lowest BMI quartile (p<.001). BMI was associated with all-cause and cause-specific mortality even after controlling for sex. A multivariate Cox proportional hazards model identified that even after controlling for male gender, age, renal failure, and diabetes mellitus, which increased the risk of all-cause mortality, elevated BMI decreased the allcause mortality risk. CONCLUSIONS:In very elderly subjects, elevated BMI was associated with reduced mortality risk.

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“…Although adiposity is associated with increased risk of many chronic diseases in the general population (6–9), there is some evidence that this relationship may not be so straightforward, particularly for mortality, where U- and J-shaped relationships are often observed (10–14). Furthermore, within diseased populations, increased adiposity is often associated with longer survival (15–17). …”

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confidence: 99%

Adiposity and mortality in type 1 diabetes

et al. 2009

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Background In the general population, adiposity exhibits a J- or U-shaped relationship with mortality; however, in catabolic states this relationship is often inversely linear. We have recently documented an age-independent increase in overweight/obesity in the Pittsburgh Epidemiology of Diabetes Complications study (EDC) of type 1 diabetes (T1D). As intensified insulin therapy (IIT) may promote weight gain, the impact of weight gain in T1D is of importance. We therefore assessed the association of adiposity with mortality in 655 EDC participants during twenty years of follow-up. Methods Individuals were categorized as underweight (BMI <20), normal (20≤BMI<25), overweight (25≤BMI<30), or obese (BMI≥30). Cox models were constructed using BMI and covariates at baseline, updated means during follow-up, time-varying (reflecting most recent status), and change during adulthood as predictors of mortality. Results The prevalence of IIT (3+ insulin shots daily and/or pump) increased from 7% to 82%. Overweight increased 47%; obesity increased 7-fold. There were 146 deaths. In unadjusted models BMI (modeled continuously) demonstrated a quadratic relationship with mortality (p=0.002, <0.0001, <0.0001 for baseline, updated mean, and time-varying models, respectively). However, only in the time-varying model were the obese significantly different from the normal weight. while the baseline model revealed no differences by BMI category, in both the updated mean and time varying models, the underweight were at greater risk than the normal weight (p<0.0001 both models). The nonlinear relationship of adiposity with mortality remained after adjustment for diabetes complications, biological, or socioeconomic/lifestyle risk factors, with the exception of baseline socioeconomic/lifestyle risk factors where a linear association emerged. Adjustment for waist circumference eliminated the risk in the obese. Finally, weight gain during follow-up was protective. Conclusion The relationship of adiposity with mortality in T1D now appears to resemble that of the general population, albeit with a marked increased risk in those underweight.

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Impact of body mass index on short-term outcome after acute myocardial infarction: Does excess body weight have a paradoxical protective role?

Cited by 17 publications

References 22 publications

The Peripheral Arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population

The Peripheral Arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population

Body Mass Index is Inversely Related to Mortality in Elderly Subjects

Adiposity and mortality in type 1 diabetes

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