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(Circulation. 2008;118:482-490.)
© 2008 American Heart Association, Inc.

Epidemiology

Relation Between Body Mass Index, Waist Circumference, and Death After Acute Myocardial Infarction

Marianne Zeller, PhD; Philippe Gabriel Steg, MD, PhD; Jack Ravisy, MD; Luc Lorgis, MD; Yves Laurent, MD; Pierre Sicard, PhD; Luc Janin-Manificat, MD; Jean-Claude Beer, MD; Hamid Makki, MD; Anne-Cécile Lagrost, MSc; Luc Rochette, PharmD, PhD; Yves Cottin, MD, PhD, for the RICO Survey Working Group

From the Laboratory of Experimental Cardiovascular Pathophysiology and Pharmacology, IFR santé-STIC, Faculty of Medicine, University of Burgundy, Dijon, France (M.Z., P.S., L.R.); INSERM U-698, Université Paris VII, AP-HP, Centre Hospitalier Bichat-Claude Bernard, France (P.G.S.); Service de Cardiologie, Clinique de Fontaine, Fontaine les Dijon, France (J.R.); Service de Cardiologie, CHU Bocage, Dijon, France (J.-C.B., A.-C.L., L.L., Y.C.); Service de Cardiologie, Centre Hospitalier, Semur en Auxois, France (Y.L.); Service de Cardiologie, Centre Hospitalier, Beaune, France (L.J.-M.); and Service de Cardiologie, Centre Hospitalier, Châtillon sur Seine, France (H.M.).

Correspondence to Dr Marianne Zeller, Laboratory of Experimental and Cardiovascular Physiopathology and Pharmacology, IFR santé-STIC, Faculty of Medicine, 7 Bd Jeanne d'Arc, 21000 Dijon, France. E-mail marianne.zeller{at}u-bourgogne.fr

Received November 19, 2007; accepted May 16, 2008.

Background— An elevated body mass index (BMI) has been reported to be associated with a lower rate of death after acute myocardial infarction (AMI). However, waist circumference (WC) may be a better marker of cardiovascular risk than BMI. We used data from a contemporary French population-based cohort of patients with AMI to analyze the impact of WC and BMI on death rates.

Methods and Results— We evaluated 2229 consecutive patients with AMI. Patients were classified according to BMI as normal, overweight, obese, and very obese (BMI <25, 25 to 29.9, 30 to 34.5, and >35 kg/m², respectively) and as increased waistline (WC >88/102 cm for women/men) or normal. Half of the patients were overweight (n=1044), and one quarter were obese (n=397) or very obese (n=128). Increased WC was present in half of the patients (n=1110). Increased BMI was associated with a reduced death rate, with a 5% risk reduction for each unit increase in BMI (hazard ratio, 0.95; 95% CI, 0.93 to 0.98; P<0.001). In contrast, WC as a continuous variable had no impact on all-cause death (P=0.20). After adjustment for baseline predictors of death, BMI was not independently predictive of death. The group of patients with high WC but low BMI had increased 1-year death rate.

Conclusions— Neither BMI nor WC independently predicts death after AMI. Much of the inverse relationship between BMI and the rate of death after AMI is due to confounding by characteristics associated with survival. This study emphasizes the need to measure both BMI and WC because patients with a high WC and low BMI are at high risk of death.

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