Body mass index and outcome in patients with coronary, cerebrovascular, or peripheral artery disease: findings from the FRENA registry

BACKGROUND: The relationship between body mass index (BMI) and mortality in patients with established arterial disease remains controversial. METHODS: FRENA is an ongoing, observational registry of consecutive outpatients with coronary artery disease (CAD), cerebrovascular disease, or peripheral artery disease (PAD). We examined the prognostic importance of accepted BMI categories on outcome among patients in the FRENA registry. RESULTS: In April 2008, 2274 patients (mean age, 66 years) had been enrolled, of whom 14 (0.6%) were underweight; 533 (23%) normal; 1051 (46%) overweight; and 676 (30%) were obese. Over a mean follow-up of 14 months, the incidence of major cardiovascular events (myocardial infarction, ischemic stroke, or critical limb ischemia) per 100 patient-years was: 7.1 [95% confidence interval (CI): 0.4-35]; 11 (95% CI: 8.4-14); 6.9 (95% CI: 5.6-8.5); and 8.5 (95% CI: 6.6-11), respectively. Their cardiovascular mortality was: 7.1 (95% CI: 0.4-35); 4.1 (95% CI: 5.9-11); 1.3 (95% CI: 0.9-2.3); and 1.5 (95% CI: 1.4-3.5), respectively. On multivariate analysis, the hazard ratio for cardiovascular mortality was: 2.2 (95% CI: 0.3-17); 1.0 (reference); 0.37 (95% CI: 0.20-0.69); and 0.37 (95% CI: 0.18-0.73), respectively. Survival benefit was only found in patients with CAD or PAD. Weight loss had little influence on outcome. CONCLUSION: Patients with CAD or PAD (not those with cerebrovascular disease) have an inverse correlation between BMI and cardiovascular mortality, even after adjusting for confounding variables.