Re: Relation of Body Mass Index to Outcome in Patients With Known or Suspected Coronary Artery Disease

Buettner, et al., The impact of obesity on mortality in UA/non-ST-
segment elevation myocardial infarction

European Heart Journal Advance Access first published online on June
18, 2007
This version published online on June 20, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm220

Aims: Obesity is associated with diabetes mellitus and advanced
coronary artery disease (CAD). Once a non-ST-elevation acute coronary
syndrome has occurred, the association between obesity and prognosis
is poorly defined. This study was designed to assess the impact of
obesity on outcome after unstable angina/non-ST-segment elevation
myocardial infarction (UA/NSTEMI) treated with early
revascularization.

Methods and results: In a prospective cohort study in 1676 consecutive
patients with UA/NSTEMI we examined the association between presence
of obesity and all-cause mortality. All patients underwent coronary
angiography and, if appropriate, early catheter-based
revascularization. Patients were divided into four groups according to
body mass index (BMI): normal, 18.5-24.9 (n = 551); overweight, 25-
29.9 (n = 824); obese, 30-34.9 (n = 244); and very obese, above 35 (n
= 48). Obese and very obese patients were younger and had a higher
incidence of hypertension, diabetes mellitus, elevated cardiac
troponin T, and C-reactive protein levels. The angiographic extent of
CAD was similar among the BMI groups. Median follow-up was 17
(interquartile range 6-31) months. Cumulative 3-year mortality rates
were 9.9% for normal BMI, 7.7% for overweight, 3.6% for obese, and 0
(no death) for very obese (log-rank P = 0.043). Obese and very obese
patients had less than half the long-term mortality when compared with
normal BMI patients [hazard ratio (HR) 0.38, 95% confidence interval
(CI) 0.18-0.81, P = 0.012]. This result remained significant after
adjustment for confounding prognostic factors including coronary
status and left ventricular function (adjusted HR 0.27, 95% CI 0.08-
0.92, P = 0.036).

Conclusion: Obesity is associated with improved outcome after UA/
NSTEMI treated with early revascularization.

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The Science Daily article on this is at http://www.sciencedaily.com/releases/2007/06/070620073447.htm.

Marilyn

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