Lean body mass index prognostic value for cardiovascular events in patients with coronary artery disease

Abstract

ObjectiveLittle is known about the relationship between body composition indicators, including body mass index (BMI), fat mass index (FMI) and lean BMI (LBMI), and adverse outcomes after percutaneous coronary intervention (PCI) in Asian populations. The aim of this study was to clarify this relationship.MethodsThe SHINANO registry is a prospective, observational, multicenter cohort registry that enrolled 1923 consecutive patients with coronary heart disease (CHD) from August 2012 to July 2013; 66 patients were excluded because of missing data. We evaluated 1857 patients with CHD who underwent PCI (aged 70±11 years; 23% women; BMI 23.8±3.5 kg/m2; LBMI 18.3±1.8 kg/m2; FMI 5.4±2.2 kg/m2). Patients were divided into three groups, based on BMI, LBMI and FMI tertiles, to assess the prognostic value of the three indicators. The primary endpoint was major adverse cardiac events (MACE), including all cause death, non-fatal myocardial infarction and ischaemic stroke at 1 year.ResultsOver a 1 year follow-up period (1776 patients, 95.6%), the cumulative MACE incidence was 8.7% (161 cases). Using Kaplan–Meier analysis, the MACE incidence was significantly higher in patients with lower BMI values (13.4–22.2 kg/m2) (p=0.002) and lower LBMI values (11.6–17.6 kg/m2) (p<0.001); this trend was not observed for FMI. Multivariate Cox regression analysis showed that lower LBMI but not lower BMI values were predictive of a higher MACE incidence (HR 1.55; 95% CI 1.05 to 2.30).ConclusionsLower LBMI values are associated with adverse outcomes in an Asian population with CHD undergoing PCI. LBMI is a better predictor of MACE than BMI or FMI.Clinical trial registrationUMIN-ID; 000010070.

Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

“…Likewise, sarcopenia, defined as a loss of muscle mass and associated with frailty and overall decreased functionality and increased mortality, could have harmful effects in patients with CAD, as our results suggest 23, 24, 25…”

“…[20][21][22] Likewise, sarcopenia, defined as a loss of muscle mass and associated with frailty and overall decreased functionality and increased mortality, could have harmful effects in patients with CAD, as our results suggest. [23][24][25] Overall, the inability of BMI to discriminate between fatfree mass, a protective factor, and fat mass, a factor associated with adverse outcomes, may lead to erroneous assumptions about risk of MACEs in patients with CAD and may explain why, in our cohort, BMI was not associated with MACEs. 5,6,26,27 Thus, the results of our study could not confirm the obesity paradox that has been reported in several other studies in those with CAD, [28][29][30][31][32] heart failure, [33][34][35][36] and atrial fibrillation.…”

Effect of Overweight and Obesity (Defined by Asian-Specific Cutoff Criteria) on Left Ventricular Diastolic Function and Structure in a General Korean Population

“…Additionally, the adjusted mean values of echocardiographic parameters reflecting diastolic dysfunction, remodeling and hypertrophy were significantly associated with increased BMI. These findings indicate the proportional relationship between functional and structural LV abnormalities and the degree of 29 In particular, several studies show a U-shaped association between cardiovascular death and BMI, which implies an adverse influence of underweight on cardiovascular disease. 26-28 This discrepancy appears to be attributable to features of our study design and participants.…”

A double burden of tuberculosis and diabetes mellitus and the role of vitamin D deficiency

“…25(OH)D, the half-life of which is close to 3 weeks and the concentration of which in blood is stable, is the most valuable indicator for evaluating the individual nutritional status of vitamin D. The current widely accepted vitamin D nutritional status evaluation criteria are shown in Table 1-1 (37) . (37) The prevalence of vitamin D deficiency in China is high (38) (39) . In 5531 (5-101 years old) urban Beijing residents reporting for health check-up, vitamin D deficiency and severe vitamin D deficiency percentages were 87.1 and 44.7, respectively (38) .…”

“…In 5531 (5-101 years old) urban Beijing residents reporting for health check-up, vitamin D deficiency and severe vitamin D deficiency percentages were 87.1 and 44.7, respectively (38) . A cross-sectional study including 6014 healthy elderly adults (≥ 60 years) showed that 34.1% of men and 44.0% of women presented with vitamin D deficiency (39) . A study of 418 Chinese immigrant population with mean age of 56 years in the Netherlands found that the prevalence of vitamin D deficiency in men and women was 67.9% and 53.1%, respectively (40) .…”