Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: role of "normal weight central obesity".
OBJECTIVE
This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based ona combination of body mass index (BMI) with measures of central obesity.


BACKGROUND
In CAD patients, mortality has been reported to vary inversely with BMI (“obesity paradox”). In contrast,central obesity is directly associated with mortality. Because of this bidirectionality, we hypothesized that CAD patients with normal BMI but central obesity would have worse survival compared to individuals with other combinations of BMI and central adiposity.


METHODS
We included 15,547 participants with CAD who were part of 5 studies from 3 continents. Multivariate stratifiedCox-proportional hazard models adjusted for potential confounders were used to assess mortality risk according to different patterns of adiposity that combined BMI with measures of central obesity.


RESULTS
Mean age was 66 years, 60% were men. There were 5,507 deaths over a median follow-up of 2.4 years (IQR: 0.5 to 7.4 years). Individuals with normal weight central obesity had the worst long-term survival: a person with BMI of 22 kg/m2 and waist circumference (WC) of 101 cm had higher mortality than a person with similar BMI but WC of 85 cm (HR: 1.10[95% CI: 1.05 to 1.17]), than a person with BMI of 26 kg/m2 and WC of 85 cm (HR: 1.20 [95% CI: 1.09 to 1.31]), than a person with BMI of 30 kg/m2 and WC of 85 cm (HR: 1.61 [95% CI: 1.39 to 1.86]) and than a person with BMI of 30kg/m2 and WC of 101 cm (HR: 1.27 [95% CI: 1.18 to 1.39), p < 0.0001 for all).


CONCLUSIONS
In patients with CAD, normal weight with central obesity is associated with the highest risk of mortality [corrected].
Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Thais
T
Coutinho
Kashish
K
Goel
Daniel
D
Corrêa de Sá
Rickey E
RE
Carter
David O
DO
Hodge
Charlotte
C
Kragelund
Alka M
AM
Kanaya
Marianne
M
Zeller
Jong Seon
JS
Park
Lars
L
Kober
Christian
C
Torp-Pedersen
Yves
Y
Cottin
Luc
L
Lorgis
Sang-Hee
SH
Lee
Young-Jo
YJ
Kim
Randal
R
Thomas
Véronique L
VL
Roger
Virend K
VK
Somers
Francisco
F
Lopez-Jimenez
D000368:Aged; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000401:mortality* / Q000503:physiopathology; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology* / Q000401:mortality* / Q000503:physiopathology; D012042:Registries