Body mass index, carotid plaque, and clinical outcomes in patients with coronary artery disease

OBJECTIVES: We evaluated the relationship among BMI, carotid sonographic findings, and long-term (5 years) cardiovascular events in Asian patients with coronary artery disease (CAD). PATIENTS AND METHODS: The study population consisted of 1342 consecutive patients with CAD, who were stratified into four groups according to weight status, as defined by the WHO for the Asian population: underweight (group I: BMI<18.5 kg/m, n=38); normal weight (group II: 18.5≤BMI<23.5 kg/m, n=352); overweight (group III: 23.5≤BMI<27.5 kg/m, n=700); and obese (group IV: BMI≥27.5 kg/m, n=252). All patients underwent carotid ultrasonography. Multivariate analysis was performed to identify predictors of long-term mortality, and the results were expressed in terms of hazard ratio (HR) with 95% confidence interval (95% CI). RESULTS: Compared with the other groups, groups I and II included older patients and had a higher incidence of multivessel CAD, carotid plaque (group I: 42.1%; group II: 42.3%; group III: 27.9%; group IV: 24.6%; P=0.003), and major cardiovascular events including cardiac death, acute myocardial infarction, and stroke. In multivariate analysis, old age, lower ejection fraction, high carotid intima-media thickness, and presence of carotid plaque were positive independent predictors for mortality, whereas BMI was a negative independent predictor (group II: HR=0.28, 95% CI=0.14-0.57, P<0.001; group III: HR=0.26, 95% CI=0.13-0.51, P<0.001; group IV: HR=0.08, 95% CI=0.03-0.22, P<0.001). CONCLUSION: In patients with CAD, underweight and normal-weight status was associated with higher long-term mortality rates and incidence of major cardiovascular events, suggesting that the obesity paradox is also manifested in Asian patients with CAD.