Key result
Obesity in men with suspected stable angina was associated with an 80% increased risk of acute myocardial infarction (HR 1.80) compared to normal weight, whereas overweight women had a decreased risk.
Why the study?
Does overweight or obesity affect the risk of acute myocardial infarction and mortality in male and female patients with suspected stable angina pectoris?
Cohort (n=4,131)
Yes
Does overweight or obesity affect the risk of acute myocardial infarction and mortality in male and female patients with suspected stable angina pectoris?
Hazard Ratio: 1.8 (95% CI 1.28–2.52)
Absolute Event Rate: 12.9% vs 8.8%
p-value: p=<0.01
The obesity paradox in stable angina may be gender-specific, with obesity increasing AMI and CV death risk in men but overweight decreasing AMI risk in women.
May support sex-stratified risk assessment in suspected stable angina; leaves open whether gender-specific obesity effects are causal or confounded.
BACKGROUND: A number of previous studies have suggested that overweight or obese patients with coronary artery disease (CAD) may have lower morbidity and mortality than their leaner counterparts. Few studies have addressed possible gender differences, and the results are conflicting. We examined the association between body mass index (BMI) and risk of acute myocardial infarction (AMI), cardiovascular (CV) death and all-cause mortality in men and women with suspected stable angina pectoris. METHOD: The cohort included 4164 patients with suspected stable angina undergoing elective coronary angiography between 2000 and 2004. Events were registered until the end of 2006. Hazard ratios (HR) (95% confidence intervals) were estimated using Cox regression by comparing normal weight (18.5-24.9 kg/m2) with overweight (25-29.9 kg/m2) and obese (≥30 kg/m2) patients. Underweight (<18.5 kg/m2) patients were excluded from the study. RESULTS: Of 4131 patients with complete data, 72% were males and 75% were diagnosed with significant CAD. The mean (standard deviation (SD)) age in the total population was 62 (10) years. Mean (SD) BMI was 26.8 (3.9) kg/m2, 34% was normal weight, 48% overweight and 19% obese. During follow up, a total of 337 (8.2%) experienced an AMI and 302 (7.3%) patients died, of whom 165 (4.0%) died from cardiovascular causes. We observed a significant interaction between BMI groups and gender with regards to risk of AMI (p = 0.011) and CV death (p = 0.031), but not to risk of all-cause mortality; obese men had a multivariate adjusted increased risk of AMI (HR 1.80 (1.28, 2.52)) and CV death (HR 1.60 (1.00, 2.55)) compared to normal weight men. By contrast, overweight women had a decreased risk of AMI (HR 0.56 (0.33, 0.98)) compared to normal weight women. The risk of all-cause mortality did not differ between BMI categories. CONCLUSION: Compared with normal weight subjects, obese men had an increased risk of AMI and CV death, while overweight women had a decreased risk of AMI. These findings may potentially explain some of the result variation in previous studies reporting on the obesity paradox.
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Borgeraas et al. (2014) conducted a cohort in suspected stable angina pectoris (n=4,131). Obesity (BMI ≥30 kg/m2) vs. Normal weight (BMI 18.5-24.9 kg/m2) was evaluated on Acute myocardial infarction (AMI) in men (HR 1.80, 95% CI 1.28-2.52, p=<0.01). Obesity in men with suspected stable angina was associated with an 80% increased risk of acute myocardial infarction (HR 1.80) compared to normal weight, whereas overweight women had a decreased risk.
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