title: Body composition and survival in stable coronary heart disease: impact of lean mass index and body fat in the "obesity paradox".
abstract: OBJECTIVE
  Our goal was to determine the impact of lean mass index (LMI) and body fat (BF) on survival in patients with coronary heart disease (CHD).
  
  
  BACKGROUND
  An inverse relationship between obesity and prognosis has been demonstrated (the "obesity paradox") in CHD, which has been explained by limitations in the use of body mass index in defining body composition.
  
  
  METHODS
  We studied 570 consecutive patients with CHD who were referred to cardiac rehabilitation, stratified as Low (≤25% in men and ≤35% in women) and High (>25% in men and >35% in women) BF and as Low (≤18.9 kg/m2 in men and ≤15.4 kg/m2 in women) and High LMI, and followed for 3 years for survival.
  
  
  RESULTS
  Mortality is inversely related to LMI (p<0.0001). Mortality was highest in the Low BF/Low LMI group (15%), which was significantly higher than in the other 3 groups, and lowest in the High BF/High LMI group (2.2%), which was significantly lower than in the other 3 groups. In Cox regression analysis as categoric variables, low LMI (hazard ratio [HR]: 3.1; 95% confidence interval [CI]: 1.3 to 7.1) and low BF (HR: 2.6; 95% CI: 1.1 to 6.4) predicted higher mortality, and as continuous variables, high BF (HR: 0.91; 95% CI: 0.85 to 0.97) and high LMI (HR: 0.81; 95% CI: 0.65 to 1.00) predicted lower mortality.
  
  
  CONCLUSIONS
  In patients with stable CHD, both LMI and BF predict mortality, with mortality particularly high in those with Low LMI/Low BF and lowest in those with High LMI/High BF. Determination of optimal body composition in primary and secondary CHD prevention is needed.
authors.affiliation: Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana 70121-2483, USA. clavie@ochsner.org
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
authors.forename: Alban
authors.initials: A
authors.lastname: De Schutter
authors.forename: Dharmendrakumar A
authors.initials: DA
authors.lastname: Patel
authors.forename: Abel
authors.initials: A
authors.lastname: Romero-Corral
authors.forename: Surya M
authors.initials: SM
authors.lastname: Artham
authors.forename: Richard V
authors.initials: RV
authors.lastname: Milani
mesh_terms: D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D002423:Cause of Death / Q000639:trends; D016001:Confidence Intervals; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology