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The Effects of the Obesity Paradox and In-Hospital and One-Year Outcomes in Patients With ST Elevation Myocardial
Mina Sharbati1, Reza Heidarimoghadam1, Mohammad Rouzbahani1
1Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Insights
The obesity paradox may not exist for ST-elevation myocardial infarction (STEMI) patients. Class I obesity showed a protective effect against adverse outcomes in crude analysis, but this vanished after adjusting for confounding factors like age.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Obesity is a known risk factor for cardiovascular diseases (CVD), including diabetes, hypertension, and dyslipidemia.
- The
- obesity paradox
- suggests overweight individuals may have better outcomes than leaner counterparts.
- This study investigates the association between Body Mass Index (BMI) and outcomes in ST-elevation myocardial infarction (STEMI) patients.
Purpose of the Study:
- To analyze the relationship between BMI categories and in-hospital and one-year outcomes in STEMI patients.
- To determine if the
- obesity paradox
- is present in this patient cohort.
- To identify predictors of adverse cardiovascular events in STEMI.
Main Methods:
- A hospital-based study of 2,397 STEMI patients from the Kermanshah STEMI Registry.
- Patients were categorized by BMI: underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), class I obese (30-34.9), and class II obese (≥35).
- Multivariable logistic regression models were used to assess predictors of in-hospital and one-year outcomes.
Main Results:
- The study included patients with varying BMI: 1.79% underweight, 38.97% normal, 43.30% overweight, 13.43% class I obese, and 2.50% class II obese.
- Crude analysis indicated class I obesity was associated with reduced risk of cardiovascular death (OR 0.50), MACE3 (OR 0.47), and MACE5 (OR 0.59).
- However, multivariate analysis revealed that the protective effect of class I obesity disappeared after adjusting for confounding variables.
Conclusions:
- The apparent protective effect of class I obesity against adverse outcomes in STEMI patients may be an artifact of confounding variables, such as age.
- The
- obesity paradox
- may not be a true phenomenon in this context.
- Further research is needed to clarify the role of obesity and confounding factors in STEMI outcomes.
Background:
Obesity is strongly associated with increased cardiovascular diseases (CVD) and cardiovascular risk factors, such as diabetes mellitus, hypertension, and dyslipidemia. However, numerous studies have suggested the existence of an "obesity paradox" in which overweight and mildly obese patients often exhibit a better outcome than their leaner counterparts. Therefore, this study aimed to characterize the association between BMI and in-hospital and one-year outcomes.
Method:
This hospital-based research was conducted as a part of the Kermanshah STEMI Registry. Following the application of inclusion criteria, a total of 2,397 STEMI patients were evaluated. The data were collected using a standardized case report developed by the European Observational Registry Program (EORP). Body mass index (BMI) (kg/m2) was classified into underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), class I/mild obese (30-34.9), and class II/extreme obese (≥35) categories. The independent predictors of the in-hospital and one-year outcomes were assessed using multivariable logistic regression models.
Results:
Out of the 2397 patients, 43 (1.79%) were underweight, 934 (38.97%) were normal, 1038 (43.30%) were overweight, 322 (13.43%) were class I obese, and 60 (2.50%) were class II obese. The results of the crude analysis showed that class I obesity was protective against CV death (OR 0.50; 95% CI 0.30-0.84), MACE3 (MI, stroke, and death) (OR 0.47; 95% CI 0.29-0.76), and MACE5 (MACE3 plus unstable angina and heart failure) (OR 0.59; 95% CI 0.44-0.79).
Conclusions:
Multivariate adjustment eliminated the protective effect of class I obesity against death and MACE events. Therefore, it is possible that this protective effect does not exist and instead reflects the impact of confounding variables such as age.
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