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

MarilynMann wrote:
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.

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

One plausible explanation is that those who are obese are more likely
to receive instruction/intervention that will result in less VAT than
those who are "normal" weight.

Otoh, the latter group would retain clinically significant levels of
pathological VAT without any instruction about the need for eating
less and would thus retain a significantly higher rate of CV events,
which would be attributable to the persistence of VAT.

May GOD bless you in HIS mighty way making you healthier (hungrier)
than ever.

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
Cardiologist

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