title: Moderate overweight is beneficial and severe obesity detrimental for patients with documented atherosclerotic heart disease.
abstract: OBJECTIVE
  Obesity is paradoxically associated with enhanced survival in patients with established cardiovascular disease. We explored this paradox further by examining the influence of obesity on survival in patients with verified atherosclerotic heart disease.
  
  
  METHODS
  This retrospective registry based cohort study included all patients from the Western Denmark Heart Registry with coronary atherosclerosis confirmed by coronary angiography from January 2000 to December 2010. Patients were divided into eight groups according to body mass index (BMI) based on WHO BMI classification.
  
  
  METHODS
  Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
  
  
  RESULTS
  The study included 37 573 patients (70.7% men) with a mean age of (66.3 ± 11.1) years. During the 11 years of follow-up, 5866 (15.6%) patients died. Multivariable analysis confirmed that the risk of death was the lowest among the preobese patients (27.5 ≤ BMI<30 kg/m(2)) with adjusted HR of 0.82 (95% CI 0.71 to 0.95; p=0.008) and increased with both low (BMI<18.50 kg/m(2)) and very high (BMI ≥ 40 kg/m(2)) BMI, HR 2.04 (95% CI 1.63 to 2.57; p<0.001) and HR 1.35 (95% CI 1.05 to 1.72; p<0.01), respectively. Also the normal weight class I (18.5 ≤ BMI<23 kg/m(2)) had a significant risk of mortality HR 1.28 (95% CI 1.13 to 1.45; p<0.001). Obese classes I and II did not differ from the reference group (23 ≤ BMI<25 kg/m(2)).
  
  
  CONCLUSIONS
  Overweight atherosclerotic heart disease patients have improved survival compared with normal weight patients. Underweight and severely obese patients have increased mortality. Our results lean more towards an overweight paradox than an obesity paradox.
authors: Department of Cardiology, Gentofte Hospital, post 635, Niels Andersens Vej 65, Hellerup 2900, Denmark. Aziza.Azimi@regionh.dk
authors: Aziza
authors: A
authors: Azimi
authors: Mette Gitz
authors: MG
authors: Charlot
authors: Christian
authors: C
authors: Torp-Pedersen
authors: Gunnar H
authors: GH
authors: Gislason
authors: Lars
authors: L
authors: Køber
authors: Lisette Okkels
authors: LO
authors: Jensen
authors: Per
authors: P
authors: Thayssen
authors: Jan
authors: J
authors: Ravkilde
authors: Hans-Henrik
authors: HH
authors: Tilsted
authors: Jens Flensted
authors: JF
authors: Lassen
authors: Leif
authors: L
authors: Thuesen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000401:mortality; D050177:Overweight / Q000150:complications* / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies