title: Body composition and coronary heart disease mortality--an obesity or a lean paradox?
abstract: OBJECTIVE
  To determine the combined effects of body mass index (BMI) and body fat (BF) on prognosis in coronary heart disease (CHD) to better understand the obesity paradox.
  
  
  METHODS
  We studied 581 patients with CHD between January 1, 2000, and July 31, 2005, who were divided into low (<25) and high BMI (≥25), as well as low (≤25% men and ≤35% women) and high BF (>25% in men and >35% in women). Four groups were analyzed by total mortality during the 3-year follow-up by National Death Index: low BF/low BMI (n=119), high BF/low BMI (n=26), low BF/high BMI (n=125), and high BF/high BMI (n=311).
  
  
  RESULTS
  During the 3-year follow-up, mortality was highest in the low BF/low BMI group (11%), which was significantly (P<.001) higher than that in the other 3 groups (3.9%, 3.2%, and 2.6%, respectively); using the high BF/high BMI group as a reference, the low BF/low BMI group had a 4.24-fold increase in mortality (confidence interval [CI], 1.76-10.23; P=.001). In multivariate logistic regression for mortality, when entered individually, both high BMI (odds ratio [OR], 0.79; CI, 0.69-0.90) and high BF (OR, 0.89; CI, 0.82-0.95) as continuous variables were independent predictors of better survival, whereas low BMI (OR, 3.60; CI, 1.37-9.47) and low BF (OR, 3.52; CI, 1.34-9.23) as categorical variables were independent predictors of higher mortality.
  
  
  CONCLUSIONS
  Although both low BF and low BMI are independent predictors of mortality in patients with CHD, only patients with combined low BF/low BMI appear to be at particularly high risk of mortality during follow-up. Studies are needed to determine optimal body composition in the secondary prevention of CHD.
authors: Department of Cardiovascular Diseases, John Ochsner Heart andVascular Institute and Ochsner Clinical School-The University of Queensl and School of Medicine, New Orleans, LA, USA. clavie@ochsner.org
authors: Carl J
authors: CJ
authors: Lavie
authors: Alban
authors: A
authors: De Schutter
authors: Dharmendrakumar
authors: D
authors: Patel
authors: Surya M
authors: SM
authors: Artham
authors: Richard V
authors: RV
authors: Milani
mesh_terms: D000328:Adult; D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D015984:Causality; D002423:Cause of Death; D015897:Comorbidity; D016001:Confidence Intervals; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000401:mortality*; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors