What is the clinical evidence from this study?

Study design: Cohort. Population: Myocardial infarction (MI) survivors (n=2099). Intervention: Body roundness index (BRI) vs. BRI ≥ 3.99. Primary outcome: All-cause mortality (HR 0.62, 95% CI 0.50-0.75, p=<0.0001).

What does this research mean for the field?

There is an L-shaped relationship between body roundness index (BRI) and all-cause mortality in myocardial infarction survivors, where a BRI below 3.99 is associated with significantly higher mortality risk, while values above this threshold show no association. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the association between the body roundness index and all-cause mortality among survivors of myocardial infarction.

September 14, 2026MedicineOpen Access

Nonlinear association between body roundness index and all-cause mortality in myocardial infarction survivors

Q: What are the key findings of this study?

In myocardial infarction survivors, body roundness index (BRI) exhibited an L-shaped association with all-cause mortality, where each 1-unit increase in BRI below a threshold of 3.99 reduced mortality risk by 38% (HR 0.62).

Q: What does this research mean for the field?

There is an L-shaped relationship between body roundness index (BRI) and all-cause mortality in myocardial infarction survivors, where a BRI below 3.99 is associated with significantly higher mortality risk, while values above this threshold show no association. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between the body roundness index and all-cause mortality among survivors of myocardial infarction.

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Key result

Higher body roundness index below 3.99 linked to ~38% lower mortality post-MI.

HR 0.62
95% CI 0.50-0.75
P<0.0001
n=2,099

Why the study?

While anthropometric indices predict cardiovascular mortality, the association of the novel body roundness index with all-cause mortality in myocardial infarction survivors remains unknown.

Does body roundness index predict all-cause mortality in myocardial infarction survivors?

Key Points

To evaluate the association between the body roundness index and all-cause mortality among survivors of myocardial infarction.
Analyzed 2099 participants with previous myocardial infarction from the National Health and Nutrition Examination Survey (1999–2018) linked to the National Death Index.
Tracked mortality over a median follow-up of approximately 9 years (median follow-up duration: 6.75 years; interquartile range: 3.5–10.92 years; 15,932 personyears).
Modeled associations using multivariable Cox proportional hazards regression with generalized additive models and penalized splines to evaluate threshold effects.
Identified an L-shaped, nonlinear association between body roundness index and all-cause mortality with an inflection point at 3.99 (956 all-cause deaths recorded).
Below the 3.99 threshold, each 1-unit increase in body roundness index significantly lowered mortality risk (hazard ratio = 0.62, 95% CI: 0.50–0.75, P < .0001).
Above the 3.99 threshold, body roundness index was not significantly associated with mortality (hazard ratio = 1.02, 95% CI: 0.98–1.06, P = .4242).

Study Design

Type

Cohort (n=2,099)

Structured PICO

Does body roundness index predict all-cause mortality in myocardial infarction survivors?

Population

2,099 U.S. adults aged 18 and older with a history of myocardial infarction, followed for a median of 6.75 years to assess the association between body roundness index and all-cause mortality.

Exposure

Body Roundness Index (BRI) calculated from height and waist circumference

Outcome

All-cause mortality ascertained via National Death Index linkage at median 6.75 years follow-uphard clinical

Main Result

Hazard Ratio: 0.62 (95% CI 0.5–0.75)

p-value: p=<0.0001

In myocardial infarction survivors, a lower Body Roundness Index (below 3.99) is associated with a significantly higher risk of all-cause mortality, suggesting that maintaining a moderate level of adiposity may confer survival benefits.

Limitations

Causality cannot be established in an observational study.
BRI was measured only at baseline, not accounting for changes over time.
Residual confounding is possible from unmeasured factors like dietary quality, specific medications, or disease severity.
Unweighted analysis limits generalizability of prevalence estimates to the U.S. MI survivor population.
Heterogeneous population without data on time since MI or cardiac rehabilitation.
Unable to examine cardiovascular-specific versus non-cardiovascular mortality separately.
Causality cannot be established in an observational study
BRI was measured only at baseline, not accounting for changes in weight or waist over time
Residual confounding is possible from unmeasured factors like dietary quality, specific medications, or disease severity (e.g., LVEF, extent of coronary disease)
Did not use NHANES sampling weights, meaning results are not strictly generalizable to the U.S. MI survivor population in terms of prevalence estimates
Heterogeneous population regarding time since MI and subsequent treatments, without data on cardiac rehabilitation
Focused only on all-cause mortality without examining cardiovascular-specific and non-cardiovascular mortality separately

Implication

May support BRI as post-MI mortality marker; leaves open whether targeting adiposity improves survival.

Abstract

While anthropometric indices predict cardiovascular mortality, the novel body roundness index (BRI)‘s association with all-cause mortality in myocardial infarction (MI) survivors remains unknown. This cohort study analyzed 2099 National Health and Nutrition Examination participants (1999–2018) with prior MI. Mortality was ascertained via National Death Index linkage (median follow-up ~ 9 years). Using Cox regression with covariate adjustment and penalized splines, we identified an L-shaped BRI-mortality relationship with an inflection point at 3.99. Below this threshold, each 1-unit BRI increase significantly reduced mortality risk (hazard ratio = 0.62, 95% CI: 0.50–0.75, P < .0001). Above 3.99, BRI showed no association (hazard ratio = 1.02, 95% CI: 0.98–1.06, P = .4242). This threshold pattern persisted in subgroups. Our findings first demonstrate that lower BRI was associated with higher mortality in MI survivors, suggesting maintaining BRI above critical thresholds may confer survival benefits.

Discussion

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Published by Medicine · CC BY-NC

Cite This Study

Qin et al. (2026) conducted a cohort in Myocardial infarction (MI) survivors (n=2,099). Body roundness index (BRI) vs. BRI ≥ 3.99 was evaluated on All-cause mortality (HR 0.62, 95% CI 0.50-0.75, p=<0.0001). In myocardial infarction survivors, body roundness index (BRI) exhibited an L-shaped association with all-cause mortality, where each 1-unit increase in BRI below a threshold of 3.99 reduced mortality risk by 38% (HR 0.62).

synapsesocial.com/papers/6aa7b26d0926e14a848b0dbe https://doi.org/10.1097/md.0000000000050531

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Implication

May support BRI as post-MI mortality marker; leaves open whether targeting adiposity improves survival.

Nonlinear association between body roundness index and all-cause mortality in myocardial infarction survivors

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Nonlinear association between body roundness index and all-cause mortality in myocardial infarction survivors

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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