title: Body mass index, carotid plaque, and clinical outcomes in patients with coronary artery disease.
abstract: OBJECTIVE
  We evaluated the relationship among BMI, carotid sonographic findings, and long-term (5 years) cardiovascular events in Asian patients with coronary artery disease (CAD).
  
  
  METHODS
  The study population consisted of 1342 consecutive patients with CAD, who were stratified into four groups according to weight status, as defined by the WHO for the Asian population: underweight (group I: BMI<18.5 kg/m, n=38); normal weight (group II: 18.5≤BMI<23.5 kg/m, n=352); overweight (group III: 23.5≤BMI<27.5 kg/m, n=700); and obese (group IV: BMI≥27.5 kg/m, n=252). All patients underwent carotid ultrasonography. Multivariate analysis was performed to identify predictors of long-term mortality, and the results were expressed in terms of hazard ratio (HR) with 95% confidence interval (95% CI).
  
  
  RESULTS
  Compared with the other groups, groups I and II included older patients and had a higher incidence of multivessel CAD, carotid plaque (group I: 42.1%; group II: 42.3%; group III: 27.9%; group IV: 24.6%; P=0.003), and major cardiovascular events including cardiac death, acute myocardial infarction, and stroke. In multivariate analysis, old age, lower ejection fraction, high carotid intima-media thickness, and presence of carotid plaque were positive independent predictors for mortality, whereas BMI was a negative independent predictor (group II: HR=0.28, 95% CI=0.14-0.57, P<0.001; group III: HR=0.26, 95% CI=0.13-0.51, P<0.001; group IV: HR=0.08, 95% CI=0.03-0.22, P<0.001).
  
  
  CONCLUSIONS
  In patients with CAD, underweight and normal-weight status was associated with higher long-term mortality rates and incidence of major cardiovascular events, suggesting that the obesity paradox is also manifested in Asian patients with CAD.
authors.affiliation: aDepartment of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju bDivision of Cardiology, Konyang University Hospital, Daejeon cDepartment of Cardiology, Andong Sungso Hospital, Andong, South Korea.
authors.forename: Hyun Woong
authors.initials: HW
authors.lastname: Park
authors.forename: Ki-Hong
authors.initials: KH
authors.lastname: Kim
authors.forename: In Girl
authors.initials: IG
authors.lastname: Song
authors.forename: Taek-Geun
authors.initials: TG
authors.lastname: Kwon
authors.forename: Wan Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Jang-Ho
authors.initials: JH
authors.lastname: Bae
mesh_terms: D015992:Body Mass Index; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014463:Ultrasonography