The obesity paradox in patients with acute coronary syndromes over 2 decades - the ACSIS registry 2000‐2018

Gurevitz, Chen; Assali, Aseel; Mohsan, Jamil; Gmach, Shirly Fluk; Beigel, Roy; Ovdat, Tal; Zwas, Donna R.; Kornowski, Ran; Orvin, Katia; Eisen, Alon

doi:10.1016/j.ijcard.2023.03.038

Cited by 5 publications

(2 citation statements)

References 32 publications

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“…These results are consistent with a large meta-analysis on BMI and all-cause mortality including > 10 million participants, which also reported the lowest all-cause mortality for normal weight patients [ 21 ]. On the other hand, studies involving patients with chronic coronary artery disease [ 20 , 22 , 23 ], acute coronary syndromes [ 24 ], DM [ 25 ], heart failure [ 26 ], and cancer [ 27 ] reported the lowest mortality for overweight patients or obese patients and an increase in mortality for underweight patients and for subjects in class II or III obesity. In our subgroup analyses of patients after MI and patients with DM we also observed presence of obesity paradox with lowest mortality for overweight patients and patients living with class I obesity.…”

Section: Discussionmentioning

confidence: 99%

“…On the basis of data from other epidemiological studies as well as from the fact that the obesity paradox appeared after adjustment for clinical characteristic including comorbidities and that weight loss was associated with worse long-term prognosis, we might assume that in most patients, weight loss was unintentional. As mentioned earlier the concept of the obesity paradox was seen mostly in observational studies that in vast majority do not have information on whether body weight loss was intentional or not [ 24 , 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

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Association of body mass index and long-term mortality in patients from nationwide LIPIDOGRAM 2004–2015 cohort studies: no obesity paradox?

Osadnik,

Nowak,

Osadnik

et al. 2023

Cardiovasc Diabetol

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Background An obesity paradox has been described in relation to adverse clinical outcomes (e.g., mortality) with lower body mass index (BMI). Aims We sought to evaluate the association between BMI and weight loss with long-term all-cause mortality in adult populations under the care of family physicians. Methods LIPIDOGRAM studies were conducted in primary care in Poland in 2004, 2006, and 2015 and enrolled a total of 45,615 patients. The LIPIDOGRAM Plus study included 1627 patients recruited in the LIPIDOGRAM 2004 and repeated measurements in 2006 edition. Patients were classified by BMI categories as underweight, normal weight, overweight and class I, II, or III (obesity). Follow-up data up to December 2021 were obtained from the Central Statistical Office. Differences in all-cause mortality were analyzed using Kaplan‒Meier and Cox regression analyses. Results Of 45,615 patients, 10,987 (24.1%) were normal weight, 320 (0.7%) were underweight, 19,134 (41.9%) were overweight, and 15,174 (33.2%) lived with obesity. Follow-up was available for 44,620 patients (97.8%, median duration 15.3 years, 61.7% females). In the crude analysis, long-term all-cause mortality was lowest for the normal-weight group (14%) compared with other categories. After adjusting for comorbidities, the highest risk of death was observed for the class III obesity and underweight categories (hazard ratio, HR 1.79, 95% CI [1.55–2.05] and HR 1.57, 95% CI [1.22–2.04]), respectively. The LIPIDOGRAM Plus analysis revealed that a decrease in body weight (by 5 and 10%) over 2 years was associated with a significantly increased risk of death during long-term follow-up—HR 1.45 (95% CI 1.05–2.02, p = 0.03) and HR 1.67 (95% CI 1.02–2.74, p < 0.001). Patients who experienced weight loss were older and more burdened with comorbidities. Conclusions Being underweight, overweight or obese is associated with a higher mortality risk in a population of patients in primary care. Patients who lost weight were older and more burdened with cardiometabolic diseases, which may suggest unintentional weight loss, and were at higher risk of death in the long-term follow-up. In nonsmoking patients without comorbidities, the lowest mortality was observed in those with a BMI < 25 kg/m2, and no U-curve relationship was observed.

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