title: Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data.
abstract: OBJECTIVE
  The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients.
  
  
  BACKGROUND
  The question of which measure of obesity better predicts survival in patients with CAD is controversial.
  
  
  METHODS
  We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months.
  
  
  RESULTS
  From 2,188 studies found, 6 met inclusion criteria. We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort. A variable called "central obesity" was created on the basis of tertiles of WHR or WC. Cox-proportional hazards were adjusted for age, sex, and confounders. The final sample consisted of 15,923 subjects. There were 5,696 deaths after a median follow-up of 2.3 (interquartile range 0.5 to 7.4) years. Central obesity was associated with mortality (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.58 to 1.83), whereas BMI was inversely associated with mortality (HR: 0.64, 95% CI: 0.59 to 0.69). Central obesity was also associated with higher mortality in the subset of subjects with normal BMI (HR: 1.70, 95% CI: 1.52 to 1.89) and BMI ≥30 kg/m(2) (HR: 1.93, 95% CI: 1.61 to 2.32).
  
  
  CONCLUSIONS
  In subjects with CAD, including those with normal and high BMI, central obesity but not BMI is directly associated with mortality.
authors.affiliation: Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Thais
authors.initials: T
authors.lastname: Coutinho
authors.forename: Kashish
authors.initials: K
authors.lastname: Goel
authors.forename: Daniel
authors.initials: D
authors.lastname: Corrêa de Sá
authors.forename: Charlotte
authors.initials: C
authors.lastname: Kragelund
authors.forename: Alka M
authors.initials: AM
authors.lastname: Kanaya
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
authors.forename: Jong-Seon
authors.initials: JS
authors.lastname: Park
authors.forename: Lars
authors.initials: L
authors.lastname: Kober
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.forename: Luc
authors.initials: L
authors.lastname: Lorgis
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Lee
authors.forename: Young-Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Randal
authors.initials: R
authors.lastname: Thomas
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
authors.forename: Virend K
authors.initials: VK
authors.lastname: Somers
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Jimenez
mesh_terms: D000818:Animals; D015992:Body Mass Index; D015331:Cohort Studies; D003299:Cooperative Behavior; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D056128:Obesity, Abdominal / Q000150:complications* / Q000401:mortality*; D015996:Survival Rate / Q000639:trends