Obesity was associated with a lower risk of overall death (OR 0.55; 95% CI 0.49-0.63; p<0.05) and other primary outcomes in patients with acute coronary syndrome, confirming an obesity paradox.
Meta-Analysis (n=585,919)
Does body mass index category affect in-hospital and follow-up outcomes in patients with acute coronary syndrome?
In patients with acute coronary syndrome, obesity is associated with lower rates of primary and secondary adverse outcomes, confirming the persistence of an 'obesity paradox'.
Odds Ratio: 0.55 (95% CI 0.49–0.63)
p-value: p=<0.05
BACKGROUND: Obesity is an important risk factor for the development of dyslipidemia, diabetes mellitus, hypertension, coronary artery disease, ventricular dysfunction, congestive heart failure (HF), stroke, and cardiac arrhythmias. OBJECTIVES: This meta-analysis brings comprehensive evaluation about still controversial association between the body mass index (BMI) and the outcomes of acute coronary syndrome. METHOD: PubMed/ScienceDirect databases were systematically searched for studies with baseline parameters, primary (HF, cardiogenic shock, cardiac arrest, reinfarction, stroke, death, total in-hospital complications) and secondary outcomes (reinfarction, stroke, death, total major adverse cardiovascular events MACE) in relation to BMI strictly classified into four groups (underweight <18. 5 kg/m2, normal weight 18. 5-24. 9 kg/m2, overweight 25. 0-29. 9 kg/m2, and obese ≥30. 0 kg/m2, grouped into mildly obese 30. 0-34. 9 kg/m2 and severely obese ≥35. 0 kg/m2). RESULTS: We included 24 studies, with 585, 919 participants (55. 5% males), aged 66. 8 years. Underweight was negatively associated with hypertension, hyperlipidemia and diabetes, and positively with primary outcomes HF (odds ratio OR = 1. 37, confidence interval CI 1. 15-1. 63), cardiogenic shock (OR = 1. 43, CI 1. 04-1. 98), stroke (OR = 1. 21, CI 1. 05-1. 40), overall death (OR = 1. 64, CI 1. 20-2. 26), total in-hospital complications (OR = 1. 39, CI 1. 24-1. 56) and secondary outcomes during 34-month follow-up cardiovascular/overall death (OR = 3. 78, CI 1. 69-8. 49/OR = 2. 82, CI 2. 29-3. 49), respectively, total MACE (OR = 2. 77, CI 2. 30-3. 34) (for all p < 0. 05). Obesity had positive association with hypertension, hyperlipidemia, diabetes and smoking, and negative with primary outcomes reinfarction (OR = 0. 83, CI 0. 76-0. 91), stroke (OR = 0. 67, CI 0. 54-0. 85), overall death (OR = 0. 55, CI 0. 49-0. 63), total in-hospital complications (OR = 0. 81, CI 0. 70-0. 93) and secondary outcomes cardiovascular/overall death (OR = 0. 77, CI 0. 66-0. 88/OR = 0. 62, CI 0. 53-0. 72), respectively, total MACE (OR = 0. 63, CI 0. 60-0. 77) (for all p < 0. 05). This negative association with several primary outcomes (cardiogenic shock, overall death, total in-hospital complications) and secondary outcomes (cardiovascular/overall death, total MACE) was more pronounced in mild obesity (p < 0. 05). These results give an "obesity paradox" with a bimodal pattern (slightly U-shaped). CONCLUSIONS: Obesity is positively associated with traditional cardiovascular risk factors and negatively with primary and secondary outcomes, which confirms the persistence of overall "obesity paradox. "
Jelavić et al. (Sun,) conducted a meta-analysis in acute coronary syndrome (n=585,919). Obesity vs. Normal weight was evaluated on overall death (OR 0.55, 95% CI 0.49-0.63, p=<0.05). Obesity was associated with a lower risk of overall death (OR 0.55; 95% CI 0.49-0.63; p<0.05) and other primary outcomes in patients with acute coronary syndrome, confirming an obesity paradox.