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The influence of optimal medical treatment on the 'obesity paradox', body mass index and long-term mortality in patients treated with percutaneous coronary intervention: a prospective cohort study.

Schenkeveld L, Magro M, Oemrawsingh RM, Lenzen M, de Jaegere P, van Geuns RJ, Serruys PW, van Domburg RT - BMJ Open (2012)

Bottom Line: To assess whether the obesity paradox persists in the long term and to study the effect of optimal medical treatment on this phenomenon.After adjusting for OMT in the multivariate analysis, BMI did not remain an independent predictor of long-term mortality (HR: 0.90, 95% CI 0.72 to 1.12 and HR: 1.07, 95% CI: 0.80 to 1.43, respectively).Patients with a normal BMI are on suboptimal medical treatment when compared with those with a high BMI.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.

ABSTRACT

Objective: To assess whether the obesity paradox persists in the long term and to study the effect of optimal medical treatment on this phenomenon.

Design: A retrospective cohort study.

Setting: A tertiary care centre in Rotterdam.

Participants: From January 2000 to December 2005, 6332 patients undergoing percutaneous coronary intervention for coronary artery disease were categorised into underweight (body mass index (BMI)<18.5), normal (18.5-24.9), overweight (25-29.9) and obese (>30).

Primary outcome measure: Mortality.

Secondary outcome measures: Cardiac death and non-fatal myocardial infarction.

Results: Optimal medical treatment was more common in obese patients as compared with normal weight patients (85% vs 76%; p<0.001). At a mean of 6.1 years, overweight and obese patients had a lower risk of all-cause mortality (HR: 0.75, 95% CI 0.66 to 0.86 and HR: 0.72, 95% CI 0.60 to 0.87, respectively). After adjusting for OMT in the multivariate analysis, BMI did not remain an independent predictor of long-term mortality (HR: 0.90, 95% CI 0.72 to 1.12 and HR: 1.07, 95% CI: 0.80 to 1.43, respectively).

Conclusion: BMI is inversely related to long-term mortality in patients treated with percutaneous coronary intervention. Patients with a normal BMI are on suboptimal medical treatment when compared with those with a high BMI. A more optimal medical treatment in the obese group may explain the observed improved outcome in these patients.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier survival curve for all-cause mortality in normal weight, overweight and obese patients at 6-year follow-up.
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fig1: Kaplan–Meier survival curve for all-cause mortality in normal weight, overweight and obese patients at 6-year follow-up.

Mentions: Univariate and multivariate associations between BMI and long-term outcome are presented in table 3. Clinical characteristics that had a significant association on multivariate analysis were age, gender, diabetes mellitus, multivessel disease and LVEF. In univariate analyses, overweight and obese patients had more favourable long-term outcomes in terms of all-cause death (HR: 0.72, 95% CI 0.63 to 0.82 and HR: 0.61, 95% CI 0.51 to 0.74, respectively) and cardiac death (HR: 0.77, 95% CI 0.63 to 0.94 and HR: 0.73, 95% CI 0.56 to 0.95, respectively). (table 3, figure 1) Overweight patients also showed a lower risk for the composite end point of cardiac death and non-fatal MI (HR: 0.84, 95% CI 0.71 to 0.99). Most of these differences remained significant after multivariate adjustments for all baseline characteristics. However, the lower incidence of cardiac death in obese patients did not remain significant after multivariate analysis. Moreover, when adjusting for baseline characteristics and optimal medication at follow-up, overweight and obese patients had a equal long-term survival (HR: 0.90, 95% CI 0.72 to 1.12 and HR: 1.07, 95% CI 0.80 to 1.43, respectively) compared with the normal weight group.


The influence of optimal medical treatment on the 'obesity paradox', body mass index and long-term mortality in patients treated with percutaneous coronary intervention: a prospective cohort study.

Schenkeveld L, Magro M, Oemrawsingh RM, Lenzen M, de Jaegere P, van Geuns RJ, Serruys PW, van Domburg RT - BMJ Open (2012)

Kaplan–Meier survival curve for all-cause mortality in normal weight, overweight and obese patients at 6-year follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3277907&req=5

fig1: Kaplan–Meier survival curve for all-cause mortality in normal weight, overweight and obese patients at 6-year follow-up.
Mentions: Univariate and multivariate associations between BMI and long-term outcome are presented in table 3. Clinical characteristics that had a significant association on multivariate analysis were age, gender, diabetes mellitus, multivessel disease and LVEF. In univariate analyses, overweight and obese patients had more favourable long-term outcomes in terms of all-cause death (HR: 0.72, 95% CI 0.63 to 0.82 and HR: 0.61, 95% CI 0.51 to 0.74, respectively) and cardiac death (HR: 0.77, 95% CI 0.63 to 0.94 and HR: 0.73, 95% CI 0.56 to 0.95, respectively). (table 3, figure 1) Overweight patients also showed a lower risk for the composite end point of cardiac death and non-fatal MI (HR: 0.84, 95% CI 0.71 to 0.99). Most of these differences remained significant after multivariate adjustments for all baseline characteristics. However, the lower incidence of cardiac death in obese patients did not remain significant after multivariate analysis. Moreover, when adjusting for baseline characteristics and optimal medication at follow-up, overweight and obese patients had a equal long-term survival (HR: 0.90, 95% CI 0.72 to 1.12 and HR: 1.07, 95% CI 0.80 to 1.43, respectively) compared with the normal weight group.

Bottom Line: To assess whether the obesity paradox persists in the long term and to study the effect of optimal medical treatment on this phenomenon.After adjusting for OMT in the multivariate analysis, BMI did not remain an independent predictor of long-term mortality (HR: 0.90, 95% CI 0.72 to 1.12 and HR: 1.07, 95% CI: 0.80 to 1.43, respectively).Patients with a normal BMI are on suboptimal medical treatment when compared with those with a high BMI.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.

ABSTRACT

Objective: To assess whether the obesity paradox persists in the long term and to study the effect of optimal medical treatment on this phenomenon.

Design: A retrospective cohort study.

Setting: A tertiary care centre in Rotterdam.

Participants: From January 2000 to December 2005, 6332 patients undergoing percutaneous coronary intervention for coronary artery disease were categorised into underweight (body mass index (BMI)<18.5), normal (18.5-24.9), overweight (25-29.9) and obese (>30).

Primary outcome measure: Mortality.

Secondary outcome measures: Cardiac death and non-fatal myocardial infarction.

Results: Optimal medical treatment was more common in obese patients as compared with normal weight patients (85% vs 76%; p<0.001). At a mean of 6.1 years, overweight and obese patients had a lower risk of all-cause mortality (HR: 0.75, 95% CI 0.66 to 0.86 and HR: 0.72, 95% CI 0.60 to 0.87, respectively). After adjusting for OMT in the multivariate analysis, BMI did not remain an independent predictor of long-term mortality (HR: 0.90, 95% CI 0.72 to 1.12 and HR: 1.07, 95% CI: 0.80 to 1.43, respectively).

Conclusion: BMI is inversely related to long-term mortality in patients treated with percutaneous coronary intervention. Patients with a normal BMI are on suboptimal medical treatment when compared with those with a high BMI. A more optimal medical treatment in the obese group may explain the observed improved outcome in these patients.

No MeSH data available.


Related in: MedlinePlus