title: Clustering of metabolic abnormalities among obese patients and mortality after percutaneous coronary intervention.
abstract: Although current literature demonstrates metabolic abnormalities are associated with mortality, obese patients who tend to have more metabolic abnormalities paradoxically have lower overall mortality rates compared to their normal-weight counterparts. In this study, we examined the prevalence of metabolic abnormality clustering and its relation to mortality in obese and normal-weight patients after percutaneous coronary intervention (PCI). Patients (n = 9,673) undergoing elective PCI from October 2003 through December 2006 at a single urban hospital were categorized by body mass index (BMI) levels of 18.5 to 24.9, 25.0 to 29.9, 30.0 to 34.9, and ≥35 kg/m(2) and by number of metabolic abnormalities possessed (hypertension, impaired fasting glucose/diabetes, triglycerides ≥150 mg/dl, high-density lipoprotein cholesterol < 40 mg/dl, and C-reactive protein ≥2.0 mg/L). All-cause mortality was assessed through June 30, 2007. Mean age of patients was 65.9 years and 66% were men. Prevalences of 4 or 5 metabolic abnormalities were 12%, 18%, 24%, and 31% in patients with BMI levels of 18.5 to 24.9, 25.0 to 29.9, 30 to 34.9, and ≥35 kg/m(2), respectively. In patients with BMI of 30.0 to 34.9 kg/m(2), hazard ratios (95% confidence intervals) for mortality associated with 2, 3, and 4 to 5 metabolic abnormalities versus 0 to 1 metabolic abnormality were 1.31 (0.79 to 2.17), 1.42 (0.83 to 2.43), and 2.39 (1.24 to 4.59), respectively. Analogous hazard ratios for patients with BMI ≥35 kg/m(2) were 1.94 (0.90 to 4.20), 1.44 (0.63 to 3.28), and 2.17 (0.91 to 5.18). All-cause mortality rates per 1,000 person-years were 55.5, 33.7, 28.3, and 33.8 in patients with BMI levels of 18.5 to 24.9, 25 to 29.9, 30 to 34.9, and ≥35 kg/m(2), respectively. In conclusion, BMI levels of 25.0 to 29.9 and 30 to 34.9 kg/m(2) were associated with lower all-cause mortality after PCI. However, an increased number of metabolic abnormalities translated into increased all-cause mortality.
authors.affiliation: The Mount Sinai Cardiovascular Institute, New York, New York, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Bashey
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.forename: Ricardo
authors.initials: R
authors.lastname: Esquitin
authors.forename: Louai
authors.initials: L
authors.lastname: Razzouk
authors.forename: Shiny
authors.initials: S
authors.lastname: Mathewkutty
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Wildman
authors.forename: April P
authors.initials: AP
authors.lastname: Carson
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kim
authors.forename: Pedro R
authors.initials: PR
authors.lastname: Moreno
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D008076:Cholesterol, HDL / Q000097:blood; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D009765:Obesity / Q000150:complications / Q000378:metabolism* / Q000401:mortality*; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D014280:Triglycerides; D002097:C-Reactive Protein