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

Medical Therapies and Invasive Treatments for Coronary Artery Disease
by Body Mass: The “Obesity Paradox” in the Get With The Guidelines
Database

Benjamin A. Steinberg BAa, b, Christopher P. Cannon MDb, , , Adrian F.
Hernandez MDc, d, Wenqin Pan PhDc, Eric D. Peterson MD, MPHc, d, Gregg
C. Fonarow MDe and for the GWTG Scientific Advisory Committee and
Investigators

aJohns Hopkins School of Medicine, Baltimore, Maryland
bThrombolysis In Myocardial Infarction (TIMI) Study Group,
Cardiovascular Division, Brigham and Women's Hospital and Harvard
Medical School, Boston, Massachusetts
cDuke Clinical Research Institute, Duke University Medical Center,
Durham, North Carolina
dDivision of Cardiology, Duke University Medical Center, Durham, North
Carolina
eDavid Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, California

Previous studies of hospitalized patients have suggested an “obesity
paradox” with lower short-term mortality as weight increases. We
hypothesized that some of this difference might be related to more
aggressive management. To evaluate the effect of body mass index (BMI)
on treatments and outcomes in patients with coronary artery disease
(CAD), the Get With The Guidelines database was investigated. From 409
US hospitals, 130,139 hospitalizations for CAD were identified with
documented height and weight. Patients were stratified by BMI, with
3,305 (2.5%) underweight (BMI <18.5 kg/m2), 34,697 (27%) of healthy
weight (BMI 18.5 to 24.9 kg/m2), 47,883 (37%) overweight (BMI 25 to
29.9 kg/m2), 37,686 (29%) obese (BMI 30 to 39.9 kg/m2), and 6,568 (5%)
extremely obese (BMI ≥40 kg/m2). As BMI increased, patients were
significantly younger but more likely to be men and have hypertension,
diabetes, and hyperlipidemia. Unadjusted in-hospital mortality was
highest in the underweight group (10.4%) and significantly lower in
the healthy-weight (5.4%), overweight (3.1%), obese (2.4%), and
extremely obese (2.9%) patients. Higher BMI was associated with
increased use of standard medical therapies such as aspirin, β
blockers, inhibitors of the renin-angiotensin system, and lipid-
lowering therapy in the hospital and at discharge. In adjusted
analyses, compared with the healthy-weight group, overweight and obese
patients were more likely to undergo invasive procedures and had lower
mortality (p <0.01 for all odds ratios). In conclusion, increasing BMI
appears to be associated with better use of guideline-recommended
medical treatment and invasive management of CAD, which may explain
the observed lower rates of in-hospital mortality.


The Get With The Guidelines (GWTG)—Coronary Artery Disease initiative
is supported by an unrestricted educational grant from the Merck/
Schering-Plough Pharmaceutical Partnership. The Duke Clinical Research
Institute (Durham, North Carolina) receives funding from the American
Heart Association as the GWTG analysis center. Dr. Cannon currently
receives research grant support from Accumetrics, AstraZeneca, Merck,
Merck/Schering Plough Partnership, and Schering Plough. Dr. Peterson
reports research grant support from Schering Plough, BMS, Sanofi,
Aventis, and Merck Schering. Dr. Fonarow reports research grants
received from GlaxoSmithKline, Pfizer, and Amgen.
Corresponding author: Tel: 617-278-0146; fax: 617-734-7329.


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