Abstract 3600: An Obesity Paradox Among Apparently Healthy Male Veterans
Background: Body mass index (BMI) is inversely related to mortality in patients with cardiovascular disease (CVD), the so-called obesity paradox. We studied a group of male veterans referred to exercise testing for clinical reasons, but determined to be free of CVD, to evaluate whether this occurs in such individuals.
Methods: After excluding 40 patients with BMI <20 kg/m2, we evaluated a total of 3317 consecutive men (mean age 57 ± 12 years) referred for exercise testing between 1992 and 2004. Patients were classified according to three predetermined BMI groups: 20.0 –24.9, 25.0 –29.9, and ≥30.0 kg/m2. The association of BMI and all-cause mortality was assessed by Cox proportional hazards analysis.
Results: During a mean follow-up of 5.8 ± 3.3 years, a total of 212 patients (6.4%) died. After adjusting for age, ethnicity, smoking and fitness level, subjects with BMI-defined normal weight were 60% more likely to die (HR [95% CI] 1.63 [1.21–2.19]; Figure⇓) than overweight or obese men. Further adjustment for hypertension, hypercholesterolemia and diabetes did not appreciably alter these results.
Conclusions: Veterans are a select group in that they must meet weight criteria to qualify for military service. In this cohort of apparently healthy male veterans, we observed a strong inverse relation of BMI to mortality. This warrants further investigation into the extent and nature of the obesity paradox.