title: Does the influence of obesity on prognosis differ in men and women? A study of obesity paradox in patients with acute coronary syndrome.
abstract: BACKGROUND
  Recent studies have reported the existence of obesity paradox in acute coronary syndromes (ACS). However, the occurrence of obesity paradox in men and women has not yet been thoroughly investigated, even though both genders differ in patterns and incidence of obesity.
  
  
  OBJECTIVE
  Therefore, the aim of this study was to investigate whether obesity influence on outcomes of patients with ACS varies by gender.
  
  
  METHODS
  This retrospective study included 341 patients admitted to hospital for treatment due to ACS in 2012. They were classified according to the World Health Organisation with use of body mass index (BMI) as normal weight, overweight, and obese. All patients received standard discharge medication. All-cause mortality was assessed during a mean follow-up time of 212 ± 121 days.
  
  
  RESULTS
  There were 82 (24%) normal weight, 160 (47%) overweight, and 99 (29%) obese patients. There were 252 (73.9%) men. All-cause mortality was lower in the obese and overweight vs. normal weight male patients (1.4% vs. 3.3% vs. 13.1%, respectively, p = 0.009). There was a trend favouring the normal weight and obese vs. overweight women (4.8% vs. 3.6% vs. 17.5%, respectively, p = 0.103). In the general population, after adjustment, BMI increase by one reduced risk by 15.6% (p = 0.015), and obesity reduced risk by 50.8% (p = 0.056). Obesity reduced risk for men by 69.4% (p = 0.015), and BMI increase by one reduced risk for men by 22% (p = 0.002). BMI and obesity were independent prognostic factors in men, whereas no such phenomenon was observed in women.
  
  
  CONCLUSIONS
  Only male patients seem to contribute to the obesity paradox observed in patients with ACS. The obesity paradox does not occur in female patients when considered separately. Obesity seems to have a different influence on outcomes in both genders, and this might be worthy of further studies.
authors.affiliation: 1st Department of Cardiology, Karol Marcinkowski University of Medical Sciences, University Hospital of Lord's Transfiguration, Poznan, Poland. jmigaj@ump.edu.pl.
authors.forename: Jacek
authors.initials: J
authors.lastname: Migaj
authors.forename: Edyta
authors.initials: E
authors.lastname: Prokop
authors.forename: Ewa
authors.initials: E
authors.lastname: Straburzyńska-Migaj
authors.forename: Maciej
authors.initials: M
authors.lastname: Lesiak
authors.forename: Stefan
authors.initials: S
authors.lastname: Grajek
authors.forename: Przemysław
authors.initials: P
authors.lastname: Mitkowski
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D050177:Overweight; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
keywords: acute coronary syndrome; gender; obesity; outcome