Abstract 9600: Coronary Artery Disease Patients with Normal Body Mass Index but Central Obesity Have the Worst Long-Term Survival When Compared to Other Patterns of Adiposity
Introduction: In patients with coronary artery disease (CAD), mortality risk increases directly with central obesity (waist circumference [WC] or waist-hip ratio [WHR]) and inversely with BMI (“obesity paradox”). We hypothesized that CAD patients with normal BMI but centrally obese would have increased risk of death compared to other patterns of adiposity.
Methods: We studied 15,923 subjects with established CAD who were part of 5 studies from 3 continents. We excluded 373 participants with BMI <18.5 Kg/m2 and 3863 without either WC or WHR data. Subjects were divided in 6 categories based on BMI (normal, overweight or obese) and either WC or WHR (normal or high). Multivariate Cox-proportional hazard models adjusted for age, sex, BMI, hypertension, diabetes, smoking, heart failure, creatinine level and use of aspirin, beta-blockers, and inhibitors of the renin-angiotensin system assessed mortality risk according to different patterns of adiposity, using subjects with normal BMI and normal WC or WHR as reference.
Results: Mean age was 65.7±11.0 yr, and 55% were men. There were 4699 deaths, median follow-up 4.7 years (IQR: 0.5 - 7.6 years). Results are summarized in the Table. Subjects with normal BMI but centrally obese had the worst long-term survival when compared to subjects with other patterns of adiposity. Furthermore, normal weight centrally obese subjects had 1.92 higher risk of dying than individuals with overweight BMI but normal WHR, and 1.63 higher mortality risk than subjects with obese BMI but normal WHR (P<0.002 for both).
Conclusions: Normal weight with central obesity, a body morphology pattern often clinically dismissed, is associated with the highest mortality in patients with CAD, especially when compared to individuals considered overweight or obese but without central obesity. An adverse metabolic milieu or less attention to risk assessment/modification in the setting of normal weight central obesity may explain these findings.
- © 2011 by American Heart Association, Inc.