title: Relation between body mass index, waist circumference, and death after acute myocardial infarction.
abstract: 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.
  
  
  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/m(2), 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.
authors.affiliation: Laboratory of Experimental and Cardiovascular Physiopathology and Pharmacology, IFR santé-STIC, Faculty of Medicine, 7 Bd Jeanne d'Arc, 21000 Dijon, France. marianne.zeller@u-bourgogne.fr
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Jack
authors.initials: J
authors.lastname: Ravisy
authors.forename: Luc
authors.initials: L
authors.lastname: Lorgis
authors.forename: Yves
authors.initials: Y
authors.lastname: Laurent
authors.forename: Pierre
authors.initials: P
authors.lastname: Sicard
authors.forename: Luc
authors.initials: L
authors.lastname: Janin-Manificat
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Beer
authors.forename: Hamid
authors.initials: H
authors.lastname: Makki
authors.forename: Anne-Cécile
authors.initials: AC
authors.lastname: Lagrost
authors.forename: Luc
authors.initials: L
authors.lastname: Rochette
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D009765:Obesity / Q000401:mortality*; D011237:Predictive Value of Tests; D012307:Risk Factors; D049629:Waist-Hip Ratio