title: Effect of obesity on in-hospital treatment for acute coronary syndrome complicated by new-onset heart failure.
abstract: OBJECTIVE
  Obesity has been associated with superior outcomes in heart failure (HF) and acute coronary syndrome (ACS). Although patients with new-onset HF after ACS are at a high risk, they may receive less aggressive treatment. It is unknown whether treatment practices are biased by BMI.
  
  
  RESULTS
  Consecutive patients without previous HF, who were hospitalized with ACS, and had left ventricular ejection fraction less than 40% or clinical HF were analyzed to assess the utilization of evidence-based treatment by BMI. BMI was categorized into normal (18.5 to <25 kg/m), overweight (25 to <30 kg/m), and obese (≥30 kg/m) groups. Multivariable logistic regression models were performed to examine the association of BMI with undergoing cardiac catheterization, and discharge on β-blocker or angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). Analysis included 461 patients. There were no significant differences among BMI groups in performance of cardiac catheterization or discharge on ACE inhibitor/ARB or β-blocker. Compared with normal, neither overweight nor obese BMI was significantly associated with cardiac catheterization [overweight: odds ratio (OR) 1.49, 95% confidence interval (CI) 0.82-2.72, P=0.2; obese: OR 1.75, 95% CI 0.92-3.33, P=0.09], or discharge on ACE inhibitor/ARB (overweight: OR 0.70, 95% CI 0.40-1.21, P=0.7; obese: OR 0.69, 95% CI 0.39-1.23, P=0.2), or β-blocker (overweight: OR 1.24, 95% CI 0.69-2.21, P=0.5; obese: OR 1.13, 95% CI 0.62-2.07, P=0.7).
  
  
  CONCLUSIONS
  Among patients with new-onset HF complicating ACS, there were no significant differences in evidence-based treatment practices by BMI.
authors.affiliation: Department of Internal Medicine, Cardiovascular Center 2166, Division of Cardiovascular Medicine, University of Michigan Health Systems, Ann Arbor, Michigan 48109-5853, USA. ahwu@med.umich.edu
authors.forename: Audrey H
authors.initials: AH
authors.lastname: Wu
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: James B
authors.initials: JB
authors.lastname: Froehlich
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Montgomery
authors.forename: Eva
authors.initials: E
authors.lastname: Kline-Rogers
authors.forename: Keith D
authors.initials: KD
authors.lastname: Aaronson
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000628:therapy*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015992:Body Mass Index; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D050177:Overweight / Q000150:complications; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors