Does BMI category affect all-cause mortality in high-risk patients with myocardial infarction or chronic heart failure?
The relationship between BMI and mortality is U-shaped in patients with MI, with highest mortality in underweight and obesity class II, whereas in HF, obesity class II does not significantly increase mortality risk, supporting the obesity paradox in HF.
AIMS: To explore the influence of obesity on prognosis in high-risk patients with myocardial infarction (MI) or heart failure (HF). METHODS AND RESULTS: Individual data of 21 570 consecutively hospitalized patients from five Danish registries were pooled together. After a follow-up of 10.4 years, all-cause mortality using multivariate model and adjusted hazard ratios (HR) with 95% confidence intervals were calculated. Compared with normal weight body mass index (BMI) 18.5-24.9 kg/m2, obesity class II (BMI >or= 35 kg/m2) was associated with increased risk of death in patients with MI but not HF HR = 1.23 (1.06-1.44), P = 0.006 and HR = 1.13 (0.95-1.36), P = 0.95 (P-value for interaction = 0.004). Obesity class I (BMI 30-34.9 kg/m2) was not associated with increased risk of death in MI or HF HR = 0.99 (0.92-1.08) and 1.00 (0.90-1.11), P > 0.1. Pre-obesity (BMI 25-29.9 kg/m2) was associated with decreased death risk in MI but not HF HR = 0.91 (0.87-0.96), P = 0.0006 and 1.04 (0.97-1.12), P = 0.34 (P-value for interaction = 0.007). Underweight (BMI < 18.5 kg/m2) patients were in increased death risk regardless of MI or HF HR = 1.54 (1.35-1.75) and 1.37 (1.18-1.59), P < 0.001. CONCLUSION: In patients with MI but not HF, the relationship between BMI and mortality is U-shaped with highest mortality in underweight and obese class II, but lowest in the other BMI classes.
Abdulla et al. (Wed,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: