title: Body Mass Index as a Predictor of Sudden Cardiac Death and Usefulness of the Electrocardiogram for Risk Stratification.
abstract: Evidence of the role of body mass index (BMI) as a risk factor for sudden cardiac death (SCD) is conflicting, and how electrocardiographic (ECG) SCD risk markers perform in subjects with different BMIs is not known. In this study, a general population cohort consisting of 10,543 middle-aged subjects (mean age 44 years, 52.7% men) was divided into groups of lean (BMI <20, n = 374), normal weight (BMI 20.0 to 24.9, n = 4,334), overweight (BMI 25.0 to 29.9, n = 4,390), and obese (BMI >30, n = 1,445) subjects. Cox proportional hazards models adjusted for confounders were used to assess the risk for SCD associated with BMI and the risk for SCD associated with ECG abnormalities in subjects with different BMIs. The overweight and obese subjects were at increased risk for SCD (hazard ratios [95% CIs] were 1.33 [1.13 to 1.56], p = 0.001 and 1.79 [1.44 to 2.23], p <0.001 for overweight and obese subjects, respectively). The risk of non-SCD had a similar relation with BMI as SCD. Hazard ratios associated with ECG abnormalities were 3.03, 1.75, 1.74, and 1.34 in groups of lean, normal weight, overweight, and obese subjects, respectively, but no statistical significance was reached in the obese. ECG abnormalities improved integrated discrimination indexes and continuous net reclassification indexes statistically significantly only in the normal weight group. In conclusion, the overweight and obese are at increased risk for SCD but also for non-SCD, and ECG abnormalities are associated with increased risk of SCD also in normal weight subjects presenting with less traditional cardiovascular risk factors.
authors.affiliation: Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland. Electronic address: antti.eranti@helsinki.fi.
authors.forename: Antti
authors.initials: A
authors.lastname: Eranti
authors.affiliation: Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Aapo L
authors.initials: AL
authors.lastname: Aro
authors.affiliation: Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kerola
authors.affiliation: Medical Research Center Oulu, Department of Internal Medicine, University Hospital and University of Oulu, Oulu, Finland.
authors.forename: Jani T
authors.initials: JT
authors.lastname: Tikkanen
authors.affiliation: Department of Health, Functional Capacity, and Welfare, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Harri A
authors.initials: HA
authors.lastname: Rissanen
authors.affiliation: Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.
authors.forename: Olli
authors.initials: O
authors.lastname: Anttonen
authors.affiliation: Medical Research Center Oulu, Department of Internal Medicine, University Hospital and University of Oulu, Oulu, Finland.
authors.forename: M Juhani
authors.initials: MJ
authors.lastname: Junttila
authors.affiliation: Department of Health, Functional Capacity, and Welfare, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Paul
authors.initials: P
authors.lastname: Knekt
authors.affiliation: Medical Research Center Oulu, Department of Internal Medicine, University Hospital and University of Oulu, Oulu, Finland.
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends