Abstract 17640: Risk of Recurrent Cardiovascular Events: The Role of Adiposity in the Presence or Absence of Cardiometabolic Dysfunction in Patients With Vascular Disease
Aims: To establish the prevalence of cardiometabolic dysfunction according to body-mass index in patients with vascular disease and determine the risk of adiposity in the presence or absence of cardiometabolic dysfunction on the occurrence of cardiovascular events and mortality.
Methods & Results: We prospectively followed 4901 patients with a history of clinical cardiovascular disease from the Second Manifestations of Arterial Disease Study. Patients were classified according to body-mass index and cardiometabolic function. The presence of cardiometabolic dysfunction was defined as ≥3 of the modified NCEP metabolic syndrome criteria (abdominal adiposity replaced by elevated C-reactive protein). Cox proportional-hazards analysis was used to estimate hazard ratios for cardiovascular events and mortality. The prevalence of cardiometabolic dysfunction was 42% in normal weight, 60% in overweight and 77% in obese patients. During a median follow-up of 5.5 years 637 patients died and 643 patients experienced a major cardiovascular event. In the absence of cardiometabolic dysfunction, overweight (HR 1.15, 95%CI 0.86-1.55) and obesity (HR 0.77, 95%CI 0.40-1.49) were not associated with an increased risk of major cardiovascular events. An increased cardiovascular risk was observed in patients with cardiometabolic dysfunction and normal weight (HR 1.66, 95%CI 1.27-2.18), overweight (HR 1.49, 95%CI 1.16-1.91) and obesity (HR 1.57, 95%CI 1.15-2.13). A similar pattern was observed for vascular and all-cause mortality.
Conclusions: In patients with vascular disease, overweight and obesity in the absence of cardiometabolic dysfunction do not confer an increased risk of cardiovascular events or mortality. Alternatively, cardiometabolic dysfunction is related to an increased risk of cardiovascular events or mortality irrespective of adiposity.
- © 2013 by American Heart Association, Inc.