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Meta-analysis of the Relation of Body Mass Index to Cardiovascular Outcomes in Patients Receiving Intensive

Safi U Khan1, Muhammad U Khan1, Haris Riaz2

  • 1Department of Medicine, West Virginia University, Morgantown, West Virginia.

The American Journal of Cardiology
|January 4, 2020
PubMed

Insights

Intensive cholesterol-lowering therapy may offer greater cardiovascular benefits for individuals with normal body mass index (BMI). Obese patients might experience reduced therapy efficacy or a true therapeutic limitation.

Area of Science:

  • Cardiology
  • Metabolic Health
  • Clinical Trials

Background:

  • The effect of body mass index (BMI) on cardiovascular outcomes during intensive low-density lipoprotein cholesterol (LDL-C) lowering therapy remains unclear.
  • Understanding this relationship is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To investigate the association between BMI and cardiovascular outcomes in patients undergoing intensive LDL-C lowering therapy.
  • To compare the efficacy of more intensive versus less intensive LDL-C lowering regimens across different BMI categories.

Main Methods:

  • A meta-analysis of 29 randomized controlled trials was conducted, including data up to April 2019.
  • Therapies were categorized into more intensive (e.g., statins, PCSK9 inhibitors) and less intensive (placebo or less potent agents) LDL-C lowering.
  • Random effects meta-regressions evaluated the link between BMI and cardiovascular endpoints in 265,766 patients.

Main Results:

  • Higher BMI was associated with increased risks of cardiovascular mortality (HR 1.07), all-cause mortality (HR 1.03), myocardial infarction (HR 1.06), revascularization (HR 1.08), and major adverse cardiovascular events (MACE) (HR 1.04) per 1 kg/m² BMI increase with intensive therapy.
  • Patients with BMI <25 kg/m² demonstrated the greatest risk reduction in mortality and cardiovascular outcomes compared to those with BMI ≥30 kg/m² (p-interaction ≤0.05).

Conclusions:

  • Intensive LDL-C lowering therapy may provide greater clinical benefits for patients with normal BMI compared to those with higher BMI.
  • Potential explanations include masking of therapy efficacy by higher obese patient mortality or genuine therapeutic limitations in this group.

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