title: Risks for Cardiovascular and Cardiac Deaths in Nonobese Patients With Diabetes and Coronary Heart Disease.
abstract: OBJECTIVE
  To assess whether obese diabetic patients with coronary heart disease (CHD) have a lower risk for cardiovascular or cardiac mortalities than do nonobese diabetic patients with CHD.
  
  
  METHODS
  We conducted a prospective cohort study using data from the National Health and Nutrition Examination Survey 1999-2010 and followed up the study participants from the survey participation date until December 31, 2011. For primary analyses, we built Cox proportional hazard models restricted to diabetic patients with CHD; unadjusted and adjusted hazard rates of cardiovascular mortality were compared between obese and nonobese participants.
  
  
  RESULTS
  A total of 3,056 diabetic participants (504 with and 2,552 without CHD) and 22,556 nondiabetic participants (953 with and 21,603 without CHD) aged 20 to 79 years without malignant disease were included. Follow-up was completed in 99.8% of study participants. Hazard ratio (HR) for cardiovascular mortality for diabetic participants with CHD was significantly lower among the obese than among the nonobese (adjusted HR, 0.38; 95% CI, 0.18-0.82; P=.01); these findings were not observed in diabetic participants without CHD. Among nondiabetic participants, cumulative event rates for cardiovascular deaths were not significantly different between the obese and the nonobese, regardless of CHD status. Similar results for cardiac mortality were observed in both diabetic and nondiabetic participants.
  
  
  CONCLUSIONS
  Obesity in diabetic patients with CHD was associated with lower cardiovascular and cardiac mortality risks compared with absence of obesity. That is, nonobese patients having diabetes and CHD may have an increased risk for serious cardiovascular events.
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan. Electronic address: ttsujimoto@hosp.ncgm.go.jp.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Tsujimoto
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kajio
authors.affiliation: Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan; Department of Public Health/Health Policy, the University of Tokyo, Tokyo, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sugiyama
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D016016:Proportional Hazards Models; D014481:United States / Q000453:epidemiology; D055815:Young Adult