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Body mass index and mortality in patients with severe coronary artery diseases: A cohort study from China
Xinxing Feng1, Ce Zhang2, Lin Jiang3
1Endocrinology and Cardiovascular Disease Centre, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China.
Insights
Obesity and overweight may not increase mortality risk in triple-vessel disease (TVD) patients, showing a U-shape relationship between body mass index (BMI) and death. Underweight and severe obesity pose higher risks, influenced by treatment strategies.
Area of Science:
- Cardiology
- Public Health
- Obesity Research
Background:
- The association between body mass index (BMI) and mortality in coronary artery disease (CAD) patients remains debated.
- Triple-vessel disease (TVD) is a severe form of CAD requiring specific risk assessment.
- Understanding BMI's impact on TVD patient outcomes is crucial for personalized treatment.
Purpose of the Study:
- To investigate the relationship between BMI and all-cause mortality in patients diagnosed with TVD.
- To explore potential influences of treatment strategies (revascularization vs. medical) on this relationship.
Main Methods:
- A cohort of 8943 TVD patients were enrolled between April 2004 and February 2011.
- Patients were categorized into five BMI groups: underweight, normal weight, overweight, mild obesity, and severe obesity.
- Mortality risk was analyzed using polynomial Cox regression, with subgroup analyses for treatment strategies over a median 7.5-year follow-up.
Main Results:
- A U-shape association was observed between BMI and adjusted mortality risk in TVD patients.
- Overweight and mild obesity were linked to lower mortality compared to normal weight.
- Severe obesity showed increased mortality risk with revascularization but decreased risk with medical treatment alone.
Conclusions:
- A U-shaped curve describes the relationship between BMI and mortality in TVD patients.
- Both underweight and severe obesity are associated with increased mortality risk.
- Treatment strategy significantly modifies the impact of BMI on mortality outcomes in TVD.
Background And Aims:
It is still controversial whether obesity and overweight increase the risk of mortality for patients with coronary artery disease. The current study aimed to investigate the relationship between body mass index (BMI) and mortality in patients with triple-vessel disease (TVD).
Methods And Results:
From April 2004 to February 2011, 8943 patients with angiographically confirmed TVD were consecutively enrolled. Patients were divided into five groups according to BMI: underweight (<18.5 kg/m2), normal weight (18.5-23.9 kg/m2), overweight: (24-27.9 kg/m2), mild obesity (28-31.9 kg/m2), and severe obesity (≥32 kg/m2). The primary end point was all-cause death. Subgroup analysis was performed for treatment strategies: revascularization and medical treatment alone. During a median follow-up of 7.5 years, lower risks of mortality were observed in patients with overweight (adjusted HR 0.85, 95% CI 0.75-0.97) and mild obesity (adjusted HR 0.83, 95% CI 0.69-1.00) compared to those with normal weight. Polynomial Cox regression suggested a U-shape association between BMI and adjusted mortality risk. In the revascularization subgroup, there was a significantly higher mortality risk in patients with severe obesity (adjusted HR 1.57, 95% CI 1.03-2.40) than in those with normal weight. While in the medical treatment subgroup, mortality risk decreased as BMI increased, with the lowest risk being observed in patients with severe obesity.
Conclusion:
There is a U-shape relationship between BMI and all-cause death in patients with TVD, with increased risks among both underweight and severely obese patients. This relationship may be influenced by treatment strategies.
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