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Elevated body mass index and intermediate-term clinical outcomes after acute coronary syndromes

Eric L Eisenstein1, Darren K McGuire, Manjushri V Bhapkar

  • 1Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC 27715, USA. eisen006@mc.duke.edu

The American Journal of Medicine
|September 17, 2005
PubMed

Insights

Overweight and obese patients had better survival after acute coronary syndromes than normal-weight patients. However, rates of death or myocardial infarction were similar across body mass index (BMI) groups.

Area of Science:

  • Cardiology
  • Public Health
  • Obesity Research

Background:

  • Obesity is a known risk factor for coronary heart disease.
  • The independent impact of obesity on clinical outcomes after acute coronary syndromes (ACS) requires further quantification.

Purpose of the Study:

  • To evaluate the relationship between elevated body mass index (BMI) and clinical outcomes at 30 days, 90 days, and 1 year post-ACS.
  • To assess the association between BMI and mortality, and death or myocardial infarction after ACS.

Main Methods:

  • Analysis of 15,071 patients from the SYMPHONY and 2nd SYMPHONY trials (1997-1999).
  • Patients were categorized by BMI: normal weight (18.5-24.9 kg/m²), overweight (25-29.9 kg/m²), obese (30-34.9 kg/m²), and very obese (≥35 kg/m²).
  • Evaluated relationships between BMI and 30-day, 90-day, and 1-year mortality, and 30-day and 90-day death or myocardial infarction using multivariable adjustment.

Main Results:

  • Increasing BMI was linked to younger age, more comorbidities, and increased cardiac medication/procedure use.
  • Unadjusted mortality was higher in normal-weight patients compared to other BMI groups.
  • After adjustment, overweight and obese patients showed lower 30-day, 90-day, and 1-year mortality compared to normal-weight patients. No significant differences in death or myocardial infarction rates were observed among BMI groups.

Conclusions:

  • Overweight and moderate obesity (BMI 25-34.9 kg/m²) were associated with improved intermediate-term survival following acute coronary syndromes compared to normal weight.
  • Very obese individuals (BMI ≥35 kg/m²) did not show this survival benefit.
  • Further research is needed to elucidate the mechanisms behind the improved outcomes observed in overweight and moderately obese ACS patients.
Abstract

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