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

Eric L. Eisenstein, Darren K McGuire, Manjushri V. Bhapkar, Arni Kristinsson, Judith S. Hochman, David F. Kong, Robert M. Califf, Frans Van De Werf, William S. Yancy, L. Kristin Newby

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

PURPOSE: Obesity is a coronary disease risk factor, but its independent effect on clinical outcomes following acute coronary syndromes has not been quantified. We evaluated the relationship between elevated body mass index (BMI) and 30-day, 90-day, and 1-year clinical outcomes postacute coronary syndromes. SUBJECTS AND METHODS: Using 15 071 patients (normal weight [BMI = 18.5-24.9 kg/m2], overweight [BMI = 25-29.9 kg/m2], obese [BMI = 30-34.9 kg/m2] or very obese [BMI ≥35 kg/m2]) randomized from 1997-1999 in the SYMPHONY (Sibrafiban vs aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes) and 2nd SYMPHONY trials, we evaluated the relationships between BMI and 30-day, 90-day, and 1-year mortality and 30-day and 90-day death or myocardial infarction. RESULTS: Increasing BMI was associated with younger age, multiple comorbidities, and greater cardiac medication and procedure use; however, systolic function and coronary disease extent were similar for all BMI categories. Unadjusted Kaplan-Meier mortality estimates were higher for normal-weight patients than for all other BMI groups. After multivariable adjustment, the 30-day mortality hazard ratios (95% confidence interval [CI]) were: overweight, 0.66 (95% CI: 0.47 to 0.94); obese, 0.61 (95% CI: 0.39 to 0.97); very obese, 0.89 (95% CI: 0.48 to 1.64). Adjusted hazard ratios were similar for 90-day and 1-year mortality. There were no statistically significant differences among BMI groups in 30-day and 90-day death or myocardial infarction (unadjusted or adjusted). CONCLUSION: Overweight and obese BMI classifications were associated with better intermediate-term survival after acute coronary syndromes than normal weight and very obese, but death or myocardial infarction rates were similar. Further study is required to understand the apparent association of overweight and moderate obesity with better intermediate-term outcomes.

Original languageEnglish (US)
Pages (from-to)981-990
Number of pages10
JournalAmerican Journal of Medicine
Volume118
Issue number9
DOIs
StatePublished - Sep 2005

Fingerprint

Acute Coronary Syndrome
Body Mass Index
Confidence Intervals
Mortality
Myocardial Infarction
Weights and Measures
Coronary Disease
Obesity
Kaplan-Meier Estimate
Aspirin
Comorbidity
Survival

Keywords

  • Body mass index
  • Coronary artery disease
  • Mortality
  • Myocardial infarction
  • Obesity
  • Outcomes assessment

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Eisenstein, E. L., McGuire, D. K., Bhapkar, M. V., Kristinsson, A., Hochman, J. S., Kong, D. F., ... Newby, L. K. (2005). Elevated body mass index and intermediate-term clinical outcomes after acute coronary syndromes. American Journal of Medicine, 118(9), 981-990. https://doi.org/10.1016/j.amjmed.2005.02.017

Elevated body mass index and intermediate-term clinical outcomes after acute coronary syndromes. / Eisenstein, Eric L.; McGuire, Darren K; Bhapkar, Manjushri V.; Kristinsson, Arni; Hochman, Judith S.; Kong, David F.; Califf, Robert M.; Van De Werf, Frans; Yancy, William S.; Newby, L. Kristin.

In: American Journal of Medicine, Vol. 118, No. 9, 09.2005, p. 981-990.

Research output: Contribution to journalArticle

Eisenstein, EL, McGuire, DK, Bhapkar, MV, Kristinsson, A, Hochman, JS, Kong, DF, Califf, RM, Van De Werf, F, Yancy, WS & Newby, LK 2005, 'Elevated body mass index and intermediate-term clinical outcomes after acute coronary syndromes', American Journal of Medicine, vol. 118, no. 9, pp. 981-990. https://doi.org/10.1016/j.amjmed.2005.02.017
Eisenstein, Eric L. ; McGuire, Darren K ; Bhapkar, Manjushri V. ; Kristinsson, Arni ; Hochman, Judith S. ; Kong, David F. ; Califf, Robert M. ; Van De Werf, Frans ; Yancy, William S. ; Newby, L. Kristin. / Elevated body mass index and intermediate-term clinical outcomes after acute coronary syndromes. In: American Journal of Medicine. 2005 ; Vol. 118, No. 9. pp. 981-990.
@article{bca5ec2131f84352a19b9d4b4b2a18d9,
title = "Elevated body mass index and intermediate-term clinical outcomes after acute coronary syndromes",
abstract = "PURPOSE: Obesity is a coronary disease risk factor, but its independent effect on clinical outcomes following acute coronary syndromes has not been quantified. We evaluated the relationship between elevated body mass index (BMI) and 30-day, 90-day, and 1-year clinical outcomes postacute coronary syndromes. SUBJECTS AND METHODS: Using 15 071 patients (normal weight [BMI = 18.5-24.9 kg/m2], overweight [BMI = 25-29.9 kg/m2], obese [BMI = 30-34.9 kg/m2] or very obese [BMI ≥35 kg/m2]) randomized from 1997-1999 in the SYMPHONY (Sibrafiban vs aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes) and 2nd SYMPHONY trials, we evaluated the relationships between BMI and 30-day, 90-day, and 1-year mortality and 30-day and 90-day death or myocardial infarction. RESULTS: Increasing BMI was associated with younger age, multiple comorbidities, and greater cardiac medication and procedure use; however, systolic function and coronary disease extent were similar for all BMI categories. Unadjusted Kaplan-Meier mortality estimates were higher for normal-weight patients than for all other BMI groups. After multivariable adjustment, the 30-day mortality hazard ratios (95{\%} confidence interval [CI]) were: overweight, 0.66 (95{\%} CI: 0.47 to 0.94); obese, 0.61 (95{\%} CI: 0.39 to 0.97); very obese, 0.89 (95{\%} CI: 0.48 to 1.64). Adjusted hazard ratios were similar for 90-day and 1-year mortality. There were no statistically significant differences among BMI groups in 30-day and 90-day death or myocardial infarction (unadjusted or adjusted). CONCLUSION: Overweight and obese BMI classifications were associated with better intermediate-term survival after acute coronary syndromes than normal weight and very obese, but death or myocardial infarction rates were similar. Further study is required to understand the apparent association of overweight and moderate obesity with better intermediate-term outcomes.",
keywords = "Body mass index, Coronary artery disease, Mortality, Myocardial infarction, Obesity, Outcomes assessment",
author = "Eisenstein, {Eric L.} and McGuire, {Darren K} and Bhapkar, {Manjushri V.} and Arni Kristinsson and Hochman, {Judith S.} and Kong, {David F.} and Califf, {Robert M.} and {Van De Werf}, Frans and Yancy, {William S.} and Newby, {L. Kristin}",
year = "2005",
month = "9",
doi = "10.1016/j.amjmed.2005.02.017",
language = "English (US)",
volume = "118",
pages = "981--990",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "9",

}

TY - JOUR

T1 - Elevated body mass index and intermediate-term clinical outcomes after acute coronary syndromes

AU - Eisenstein, Eric L.

AU - McGuire, Darren K

AU - Bhapkar, Manjushri V.

AU - Kristinsson, Arni

AU - Hochman, Judith S.

AU - Kong, David F.

AU - Califf, Robert M.

AU - Van De Werf, Frans

AU - Yancy, William S.

AU - Newby, L. Kristin

PY - 2005/9

Y1 - 2005/9

N2 - PURPOSE: Obesity is a coronary disease risk factor, but its independent effect on clinical outcomes following acute coronary syndromes has not been quantified. We evaluated the relationship between elevated body mass index (BMI) and 30-day, 90-day, and 1-year clinical outcomes postacute coronary syndromes. SUBJECTS AND METHODS: Using 15 071 patients (normal weight [BMI = 18.5-24.9 kg/m2], overweight [BMI = 25-29.9 kg/m2], obese [BMI = 30-34.9 kg/m2] or very obese [BMI ≥35 kg/m2]) randomized from 1997-1999 in the SYMPHONY (Sibrafiban vs aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes) and 2nd SYMPHONY trials, we evaluated the relationships between BMI and 30-day, 90-day, and 1-year mortality and 30-day and 90-day death or myocardial infarction. RESULTS: Increasing BMI was associated with younger age, multiple comorbidities, and greater cardiac medication and procedure use; however, systolic function and coronary disease extent were similar for all BMI categories. Unadjusted Kaplan-Meier mortality estimates were higher for normal-weight patients than for all other BMI groups. After multivariable adjustment, the 30-day mortality hazard ratios (95% confidence interval [CI]) were: overweight, 0.66 (95% CI: 0.47 to 0.94); obese, 0.61 (95% CI: 0.39 to 0.97); very obese, 0.89 (95% CI: 0.48 to 1.64). Adjusted hazard ratios were similar for 90-day and 1-year mortality. There were no statistically significant differences among BMI groups in 30-day and 90-day death or myocardial infarction (unadjusted or adjusted). CONCLUSION: Overweight and obese BMI classifications were associated with better intermediate-term survival after acute coronary syndromes than normal weight and very obese, but death or myocardial infarction rates were similar. Further study is required to understand the apparent association of overweight and moderate obesity with better intermediate-term outcomes.

AB - PURPOSE: Obesity is a coronary disease risk factor, but its independent effect on clinical outcomes following acute coronary syndromes has not been quantified. We evaluated the relationship between elevated body mass index (BMI) and 30-day, 90-day, and 1-year clinical outcomes postacute coronary syndromes. SUBJECTS AND METHODS: Using 15 071 patients (normal weight [BMI = 18.5-24.9 kg/m2], overweight [BMI = 25-29.9 kg/m2], obese [BMI = 30-34.9 kg/m2] or very obese [BMI ≥35 kg/m2]) randomized from 1997-1999 in the SYMPHONY (Sibrafiban vs aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes) and 2nd SYMPHONY trials, we evaluated the relationships between BMI and 30-day, 90-day, and 1-year mortality and 30-day and 90-day death or myocardial infarction. RESULTS: Increasing BMI was associated with younger age, multiple comorbidities, and greater cardiac medication and procedure use; however, systolic function and coronary disease extent were similar for all BMI categories. Unadjusted Kaplan-Meier mortality estimates were higher for normal-weight patients than for all other BMI groups. After multivariable adjustment, the 30-day mortality hazard ratios (95% confidence interval [CI]) were: overweight, 0.66 (95% CI: 0.47 to 0.94); obese, 0.61 (95% CI: 0.39 to 0.97); very obese, 0.89 (95% CI: 0.48 to 1.64). Adjusted hazard ratios were similar for 90-day and 1-year mortality. There were no statistically significant differences among BMI groups in 30-day and 90-day death or myocardial infarction (unadjusted or adjusted). CONCLUSION: Overweight and obese BMI classifications were associated with better intermediate-term survival after acute coronary syndromes than normal weight and very obese, but death or myocardial infarction rates were similar. Further study is required to understand the apparent association of overweight and moderate obesity with better intermediate-term outcomes.

KW - Body mass index

KW - Coronary artery disease

KW - Mortality

KW - Myocardial infarction

KW - Obesity

KW - Outcomes assessment

UR - http://www.scopus.com/inward/record.url?scp=24744449938&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=24744449938&partnerID=8YFLogxK

U2 - 10.1016/j.amjmed.2005.02.017

DO - 10.1016/j.amjmed.2005.02.017

M3 - Article

C2 - 16164884

AN - SCOPUS:24744449938

VL - 118

SP - 981

EP - 990

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 9

ER -