title: Relation between body mass index, waist circumference, and cardiovascular outcomes in 19,579 diabetic patients with established vascular disease: the REACH Registry.
abstract: OBJECTIVE
  Obesity is frequent in type 2 diabetic patients with myocardial infarction (MI) or established cardiovascular disease. Earlier studies suggest that elevated body mass index (BMI) is associated with a favorable prognosis for persons with established vascular disease. We sought to analyse the associations between raised BMI and waist circumference with the 2-year event rate in type 2 diabetic patients with established vascular disease.
  
  
  RESULTS
  Patients from the Reduction of Atherothrombosis for Continued Health (REACH) Registry, an international, prospective cohort of patients at high risk of atherothrombosis, were selected if they were diabetic and had established atherosclerotic arterial disease (n = 19,579). The main outcomes after 2-year follow-up were: all-cause death, cardiovascular death, MI, stroke, cardiovascular death/MI/stroke, and cardiovascular death/MI/stroke/rehospitalization. The rates of all-cause death, cardiovascular death, and cardiovascular death/MI/stroke decreased across increasing BMI quintile categories, whereas the same rates were stable across waist categories. The hazard ratios, adjusted for confounders, decreased significantly with increasing BMI for all-cause death (p < 0.0001), cardiovascular death (p = 0.0009), cardiovascular death/MI/stroke (p = 0.0004), and all events (p = 0.002), but not for greater waist circumference.
  
  
  CONCLUSIONS
  There is an apparent obesity paradox (better outcome with increasing obesity) when obesity is measured by BMI but not when measured by waist circumference in diabetic subjects.
authors: Institut Pasteur de Lille, France; INSERM U744, 1 rue du Pr Calmette, Lille Cedex, France. jean.dallongeville@pasteur-lille.fr
authors: Jean
authors: J
authors: Dallongeville
authors: Deepak L
authors: DL
authors: Bhatt
authors: P H Gabriel
authors: PH
authors: Steg
authors: Philippe
authors: P
authors: Ravaud
authors: Peter W
authors: PW
authors: Wilson
authors: Kim A
authors: KA
authors: Eagle
authors: Shinya
authors: S
authors: Goto
authors: Jean-Louis
authors: JL
authors: Mas
authors: Gilles
authors: G
authors: Montalescot
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications* / Q000401:mortality; D048909:Diabetes Complications / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D055105:Waist Circumference