Key result
Overweight in acute coronary syndrome is linked to ~31% lower 30-day mortality vs normal weight.
Why the study?
The protective effect of obesity in ACS patients undergoing PCI or bypass surgery has been described as the obesity paradox, motivating an investigation into its pooled effect on mortality.
Does overweight or obesity reduce mortality in patients with acute coronary syndrome compared to normal weight?
Meta-Analysis (n=534,903)
Does overweight or obesity reduce mortality in patients with acute coronary syndrome compared to normal weight?
A U-shaped relationship exists between BMI and mortality in acute coronary syndrome patients, where overweight and moderately obese individuals have better survival than normal-weight or low-weight patients.
Lower mortality in overweight/obese ACS patients supports obesity paradox; extends observational data but should not yet change weight management.
Background: The protective effect of obesity in patients with acute coronary syndrome undergoing percutaneous coronary intervention or bypass surgery has been described as the obesity paradox in the literature. Aims: In this comprehensive meta-analysis, we aimed to investigate the pooled effect of the obesity paradox on mortality in acute coronary syndrome patients. Study Design: Systemic meta-analysis and metaregression. Methods: We searched PubMed, Google Scholar, and the Cochrane Library for eligible studies that compared the mortality rates between body mass index cut-off points in acute coronary syndrome patients. This meta-analysis comprised 54 studies with 534,903 patients. Random- and fixed-effect models were used to calculate pooled effects sizes in the presence of moderately high and low heterogeneity between studies, respectively. A metaregression analysis was used to detect possible causes of heterogeneity. A dose-response meta-analysis was also conducted to detect the association between mortality risk and body mass index. Conclusion: Low-weight and overweight acute coronary syndrome patients had higher mortality risk than normal-weight patients. A U-shaped nonlinear association was detected between body mass index and mortality risk.
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Şaylık et al. (2023) conducted a meta-analysis in Acute Coronary Syndrome (n=534,903). Overweight / Obesity (High Body Mass Index) vs. Normal weight was evaluated on 30-day mortality (overweight vs normal weight) (RR 0.69, 95% CI 0.62-0.76, p=< 0.01). Overweight and obese patients with acute coronary syndrome had lower 30-day and long-term mortality compared to normal-weight patients, demonstrating an obesity paradox.
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