Obesity and cardiovascular outcomes after myocardial infarction: a nationwide SWEDEHEART analysis by diabetes status

AIMS: To analyse the prevalence of obesity and its impact on long-term cardiovascular outcomes in patients with myocardial infarction (MI). METHODS: Patients with MI registered in SWEDEHEART between 2010 and 2021 were followed through December 2021 (mean follow-up time 6 years). Associated risk of adverse events in WHO Body mass index (BMI) strata was assessed in adjusted Cox proportional hazards models, stratified by diabetes status (reference: normal BMI without diabetes). RESULTS: Of 124 360 patients, 21% had diabetes. Obesity was more common among patients with diabetes (37% vs. 20%). The highest risk of mortality and major cardiovascular events (MACE; all-cause death, MI, stroke, or heart failure) was observed in those with class 3 obesity and diabetes (HR 2.15 [95% CI 1.88-2.45] and 1.91 [1.73-2.10]), with a lower risk of MACE in class 3 obesity alone (1.29; 1.16-1.45). In patients without diabetes, the risk of MACE and death was present in class 2 and class 3 obesity, but not in those with overweight or class 1 obesity. Regardless of diabetes status, obesity was less associated with atherosclerotic events than heart failure and renal events. The highest risk for heart failure and renal events was for class 3 obesity with diabetes (2.92 [2.57-3.31] and 3.36 [2.87-3.93]). CONCLUSION: In patients with myocardial infarction, obesity is common and associated with a high risk of mortality, heart failure, and renal events, especially if diabetes is present. There is a need for an increased awareness of this high-risk group with obesity and cardiovascular disease.