title: Body mass index and the prevalence, severity, and risk of coronary artery disease: an international multicentre study of 13,874 patients.
abstract: OBJECTIVE
  Obesity is associated with the presence of coronary artery disease (CAD) risk factors and cardiovascular events. We examined the relationship between body mass index (BMI) and the presence, extent, severity, and risk of CAD in patients referred for coronary computed tomographic angiography (CCTA).
  
  
  RESULTS
  We evaluated 13,874 patients from a prospective, international, multicentre registry of individuals without known CAD undergoing CCTA. We compared risk factors, CAD findings, and risk of all-cause mortality and non-fatal myocardial infarction (MI) amongst individuals with underweight (18.5-20.0 kg/m(2)), normal (20.1-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese (≥30 kg/m(2)) BMI. The mean follow-up was 2.4 ± 1.2 years with 143 deaths and 193 MIs. Among underweight, normal weight, overweight, and obese individuals, there was increasing prevalence of diabetes (7 vs.10% vs. 12 vs. 19%), hypertension (37 vs. 40% vs. 46 vs. 59%), and hyperlipidaemia (48 vs. 52% vs. 56 vs. 56%; P < 0.001 for trend). After multivariable adjustment, BMI was positively associated with the prevalence of any CAD [odds ratio (OR) 1.25 per +5 kg/m(2), 95% confidence interval (CI): 1.20-1.30, P < 0.001] and obstructive (≥50% stenosis) CAD (OR: 1.13 per +5 kg/m(2), 95% CI: 1.08-1.19, P < 0.001); a higher BMI was also associated with an increased number of segments with plaque (+0.26 segments per +5 kg/m(2), 95% CI: 0.22-0.30, P < 0.001). Larger BMI categories were associated with an increase in all-cause mortality (P = 0.004), but no difference in non-fatal MI. After multivariable adjustment, a higher BMI was independently associated with increased risk of MI (hazards ratio: 1.28 per +5 kg/m(2), 95% CI: 1.12-1.45, P < 0.001).
  
  
  CONCLUSIONS
  Amongst patients with suspected CAD referred for CCTA, individuals with increased BMI have greater prevalence, extent, and severity of CAD that is not fully explained by the presence of traditional risk factors. A higher BMI is independently associated with increased risk of intermediate-term risk of myocardial infarction.
authors.affiliation: Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, S. Mark Taper Bldg, Rm 1253, Los Angeles, CA 90048, USA.
authors.forename: Troy M
authors.initials: TM
authors.lastname: Labounty
authors.forename: Millie J
authors.initials: MJ
authors.lastname: Gomez
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.forename: Mouaz
authors.initials: M
authors.lastname: Al-Mallah
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.forename: Tracy Q
authors.initials: TQ
authors.lastname: Callister
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.forename: Victor
authors.initials: V
authors.lastname: Cheng
authors.forename: Kavitha M
authors.initials: KM
authors.lastname: Chinnaiyan
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chow
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cury
authors.forename: Augustin
authors.initials: A
authors.lastname: Delago
authors.forename: Allison
authors.initials: A
authors.lastname: Dunning
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Martin
authors.initials: M
authors.lastname: Hadamitzky
authors.forename: Jorg
authors.initials: J
authors.lastname: Hausleiter
authors.forename: Philipp
authors.initials: P
authors.lastname: Kaufmann
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.forename: Fay Y
authors.initials: FY
authors.lastname: Lin
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.forename: Gilbert
authors.initials: G
authors.lastname: Raff
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D017677:Age Distribution; D000368:Aged; D015992:Body Mass Index; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D038622:Internationality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods