title: Association of obesity and survival in systolic heart failure after acute myocardial infarction: potential confounding by age.
abstract: OBJECTIVE
  To determine the association between obesity and outcomes in post-acute myocardial infarction (AMI) patients with systolic heart failure (HF).
  
  
  RESULTS
  Of the 6632 Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) participants, 6611 had data on baseline body mass index (BMI) and 6561 had BMI > or = 18.5 kg/m(2). Of these, 1573 were obese (BMI > or = 30 kg/m(2)) and 4988 were non-obese (BMI 18.5-29.9 kg/m(2)). Propensity scores for obesity, estimated for each patient, were used to assemble a cohort of 1519 pairs of obese and non-obese patients who were balanced on 65 baseline characteristics. All-cause mortality occurred in 13.7 and 13.8% of matched obese and non-obese patients, respectively, during 16 months of median follow-up [matched hazard ratio (HR) for obesity 0.98; 95% confidence interval (CI) 0.79-1.21; P = 0.831]. Before matching, the obese group was younger (mean age, 62 vs. 64 years; P < 0.0001) and had more women (37 vs. 26%; P < 0.0001). The paradoxical pre-match association between obesity and reduced mortality (unadjusted HR 0.82; 95% CI 0.70-0.95; P = 0.008) disappeared when adjusted for age alone (age-adjusted HR 0.91; 95% CI 0.78-1.06; P = 0.206) but not for gender alone (gender-adjusted HR 0.79; 95% CI 0.68-0.92; P = 0.003). Obesity had no association with mortality in 1573 pairs of age-matched obese and non-obese patients (age-adjusted HR 0.94; 95% CI 0.77-1.13; P = 0.484).
  
  
  CONCLUSIONS
  In post-AMI patients with systolic HF, obesity provides no independent intrinsic survival benefit. The paradoxical unadjusted survival associated with obesity is largely explained by the younger age of obese patients.
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Audrey H
authors.initials: AH
authors.lastname: Wu
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: John
authors.initials: J
authors.lastname: Vincent
authors.forename: Marjan
authors.initials: M
authors.lastname: Mujib
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005260:Female; D054143:Heart Failure, Systolic / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D009765:Obesity / Q000150:complications / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis