Key result
Central obesity is linked to ~70% higher mortality in CAD, despite an inverse BMI association.
Why the study?
The measure of obesity that better predicts survival in patients with coronary artery disease is controversial.
Does central obesity predict mortality better than BMI in patients with coronary artery disease?
Meta-Analysis (n=15,923)
Yes
Does central obesity predict mortality better than BMI in patients with coronary artery disease?
Hazard Ratio: 1.7 (95% CI 1.58–1.83)
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We suspected that the obesity paradox was happening because BMI is not a good measure of body fatness and gives no insight into the distribution of fat. BMI is just a measure of weight in proportion to height. What seems to be more important is how the fat is distributed on the body.”
“Visceral fat has been found to be more metabolically active. It produces more changes in cholesterol, blood pressure and blood sugar. However, people who have fat mostly in other locations in the body, specifically, the legs and buttocks, don't show this increased risk.”
In patients with coronary artery disease, central obesity is directly associated with mortality, even in those with normal BMI, whereas BMI alone shows an inverse association (obesity paradox).
OBJECTIVES: The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients. BACKGROUND: The question of which measure of obesity better predicts survival in patients with CAD is controversial. METHODS: We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months. RESULTS: From 2,188 studies found, 6 met inclusion criteria. We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort. A variable called "central obesity" was created on the basis of tertiles of WHR or WC. Cox-proportional hazards were adjusted for age, sex, and confounders. The final sample consisted of 15,923 subjects. There were 5,696 deaths after a median follow-up of 2.3 (interquartile range 0.5 to 7.4) years. Central obesity was associated with mortality (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.58 to 1.83), whereas BMI was inversely associated with mortality (HR: 0.64, 95% CI: 0.59 to 0.69). Central obesity was also associated with higher mortality in the subset of subjects with normal BMI (HR: 1.70, 95% CI: 1.52 to 1.89) and BMI ≥30 kg/m(2) (HR: 1.93, 95% CI: 1.61 to 2.32). CONCLUSIONS: In subjects with CAD, including those with normal and high BMI, central obesity but not BMI is directly associated with mortality.
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Coutinho et al. (2011) conducted a meta-analysis in Coronary artery disease (n=15,923). Central obesity vs. Lower central obesity was evaluated on Mortality (HR 1.70, 95% CI 1.58 to 1.83). In patients with coronary artery disease, central obesity was associated with increased mortality (HR 1.70; 95% CI 1.58-1.83), whereas BMI was inversely associated with mortality.
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