title: Higher body mass index at the time of acute myocardial infarction is associated with a favorable long-term prognosis (8-year follow-up).
abstract: Obesity is an important public health problem, especially among patients with cardiovascular disease. However, little is known about the impact of obesity on the long-term prognoses of patients with acute myocardial infarction (AMI). Major adverse cardiac and cerebrovascular events (MACCE) consist of all causes of death, stroke, target lesion revascularization, target vessel revascularization, non-fatal myocardial infarction, and hospitalization. From January 2001 to March 2005, we analyzed 121 patients who survived >30 days after suffering their first AMI of the left anterior descending artery for MACCE. The mean follow-up period for this study was 59 ± 26 months. Seventy-five patients presented with normal weight (BMI <25 kg/m(2)) and 46 were obese (BMI >25 kg/m(2)). During the follow-up period, 56 patients presented MACCE, including 18 deaths, 11 strokes, and seven non-fatal myocardial infarctions. Normal weight was significantly associated with the occurrence of MACCE (p = 0.012). Grouping of the patients by BMI and homeostasis model assessment ratio (HOMA-R) indicated that the combination of a higher BMI (>25) and lower insulin resistance (HOMA-R < 2.0) provided the best prognosis (p = 0.0006). Kaplan-Meier curves stratified to the four groups, sorted by diabetes mellitus and BMI at admission, showed that the normal weight patients with diabetes mellitus presented the highest risk of MACCE (p < 0.0001). Patients with higher BMI and no insulin resistance or diabetes mellitus present better long-term outcomes following anterior AMI.
authors.affiliation: Division of Cardiovascular Medicine, Toho University Medical Center Ohashi Hospital, 2-17-6 Ohashi, Meguro-ku, Tokyo, Japan. ikedanobutaka@yahoo.co.jp
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Ikeda
authors.forename: Rintaro
authors.initials: R
authors.lastname: Nakajima
authors.forename: Makoto
authors.initials: M
authors.lastname: Utsunomiya
authors.forename: Masaki
authors.initials: M
authors.lastname: Hori
authors.forename: Hideki
authors.initials: H
authors.lastname: Itaya
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Makino
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ono
authors.forename: Masaya
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Naohiko
authors.initials: N
authors.lastname: Nemoto
authors.forename: Raisuke
authors.initials: R
authors.lastname: Iijima
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Hara
authors.forename: Takuro
authors.initials: T
authors.lastname: Takagi
authors.forename: Hisao
authors.initials: H
authors.lastname: Hara
authors.forename: Masato
authors.initials: M
authors.lastname: Nakamura
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugi
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D056988:Anterior Wall Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015992:Body Mass Index; D017023:Coronary Angiography; D048909:Diabetes Complications / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome