Key result
Underweight BMI was significantly associated with a higher risk of in-hospital mortality across all six acute cardiovascular diseases compared to normal BMI, while the impact of obesity varied by disease type.
Why the study?
BMI distribution and its impact on CVD vary between Asian and western populations, prompting an evaluation of time-related BMI trends and safe BMI ranges in Japanese patients with CVD.
Does body mass index category impact in-hospital mortality in Japanese patients with acute cardiovascular diseases?
Observational (n=5,020,464)
Yes
Does body mass index category impact in-hospital mortality in Japanese patients with acute cardiovascular diseases?
Odds Ratio: 1.41 (95% CI 1.35–1.48)
p-value: p=<0.001
Underweight is consistently associated with higher in-hospital mortality across acute cardiovascular diseases in Japan, whereas the impact of obesity varies by disease type, highlighting the need for disease-specific BMI risk stratification.
Underweight BMI signals higher acute CVD mortality risk; leaves open disease-specific obesity effects for prospective validation.
Body mass index (BMI) distribution and its impact on cardiovascular disease (CVD) vary between Asian and western populations. The study aimed to reveal time-related trends in the prevalence of obesity and underweight and safe ranges of BMI in Japanese patients with CVD. We analyzed 5,020,464 records from the national Japanese Registry of All Cardiac and Vascular Diseases—Diagnosis Procedure Combination dataset over time (2012–2019) and evaluated BMI trends and the impact on in-hospital mortality for six acute CVDs: acute heart failure (AHF), acute myocardial infarction (AMI), acute aortic dissection (AAD), ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Patients were categorized into five groups using the WHO Asian-BMI criteria: underweight (< 18.5 kg/m 2 ), normal (18.5–22.9 kg/m 2 ), overweight at risk (23.0–24.9 kg/m 2 ), obese I (25.0–29.9 kg/m 2 ), and obese II (≥ 30.0 kg/m 2 ). Age was significantly and inversely related to high BMI for all diseases (P < 0.001). The proportion of BMI categories significantly altered over time; annual BMI trends showed a significant and gradual increase, except AAD. In adjusted mixed models, underweight was significantly associated with a high risk of in-hospital mortality in all CVD patients (AHF, OR 1.41, 95% CI 1.35–1.48, P < 0.001; AMI, OR 1.27, 95% CI 1.20–1.35, P < 0.001; AAD, OR 1.23, 95% CI 1.16–1.32, P < 0.001; IS, OR 1.45, 95% CI 1.41–1.50, P < 0.001; ICH, OR 1.18, 95% CI 1.13–1.22, P < 0.001; SAH, OR 1.17, 95% CI 1.10–1.26, P < 0.001). Moreover, obese I and II groups were significantly associated with a higher incidence of in-hospital mortality, except AHF and IS. Age was associated with in-hospital mortality for all BMI categories in six CVD patients. BMI increased annually in patients with six types of CVDs. Although underweight BMI was associated with high mortality rates, the impact of obesity on in-hospital mortality differs among CVD types.
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Yoshida et al. (2022) conducted an observational in Acute cardiovascular diseases (AHF, AMI, AAD, IS, ICH, SAH) (n=5,020,464). Underweight (BMI < 18.5 kg/m2) vs. Normal BMI (18.5–22.9 kg/m2) was evaluated on In-hospital mortality (Acute Heart Failure cohort) (OR 1.41, 95% CI 1.35-1.48, p=<0.001). Underweight BMI was significantly associated with a higher risk of in-hospital mortality across all six acute cardiovascular diseases compared to normal BMI, while the impact of obesity varied by disease type.
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