Association of obesity indices with in-hospital and 1-year mortality following acute coronary syndrome
- 1 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Journal of Obesity
- Vol. 45 (2), 358-368
- https://doi.org/10.1038/s41366-020-00679-0
Abstract
Background/objectives According to the "obesity paradox", adults with obesity have a survival advantage following acute coronary syndrome, compared with those without obesity. Previous studies focused on peripheral obesity and whether this advantage is conferred by central obesity is unknown. The objective of this study was to describe the association of peripheral and central obesity indices with risk of in-hospital and 1-year mortality following acute coronary syndrome (ACS). Subjects/methods Gulf COAST is a prospective ACS registry that enrolled 4044 patients age >= 18 years from January 2012 through January 2013, across 29 hospitals in four Middle Eastern countries. Associations of indices of peripheral obesity (body-mass index, [BMI]) and central obesity (waist circumference [WC] and waist-to-height ratio [WHtR]) with mortality following ACS were analyzed in logistic regression models (odds ratio, 95% CI) with and without adjustment for Global Registry of Acute Coronary Events risk score. Results Of 3882 patients analyzed (mean age: 60 years; 33.3% women [n = 1294]), the prevalence of obesity was 34.5% (BMI >= 30.0 kg/m(2)), 72.2% (WC >= 94.0 cm [men] or >= 80.0 cm [women]) and 90.0% (WHtR >= 0.5). In adjusted models, deciles of obesity indices showed higher risk of mortality at extreme versus intermediate deciles (U-shaped). When defined by conventional cut-offs, peripheral obesity (BMI >= 30.0 versus 18.5-29.9 kg/m(2)) showed inverse association with risk of in-hospital mortality (0.64; 95% CI, 0.42-0.99;P = 0.04; central obesity showed trend toward reduced mortality). In contrast, for risk of 1-year mortality, all indices showed inverse association. Obesity, defined by presence of all three indices, versus nonobesity showed inverse association with risk of 1-year mortality (0.52; 95% CI, 0.35-0.75;P = 0.001). Results were similar among men and women. Conclusion The degree of obesity paradox following ACS depends on the obesity index and follow-up time. Obesity indices may aid in risk stratification of mortality following ACS.This publication has 51 references indexed in Scilit:
- The Obesity Paradox in Patients With Acute Coronary SyndromeAngiology, 2013
- Genetic determinants of common obesity and their value in predictionBest Practice & Research Clinical Endocrinology & Metabolism, 2012
- CVD and obesity in transitional Syria: a perspective from the Middle EastVascular Health and Risk Management, 2012
- ACCF/AHA 2011 Key Data Elements and Definitions of a Base Cardiovascular Vocabulary for Electronic Health Records: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data StandardsJournal of the American College of Cardiology, 2011
- A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary valueNutrition Research Reviews, 2010
- The Prevalence and Outcome of Excess Body Weight Among Middle Eastern Patients Presenting With Acute Coronary SyndromeAngiology, 2009
- Relation Between Body Mass Index, Waist Circumference, and Death After Acute Myocardial InfarctionCirculation, 2008
- Impact of obesity on long-term prognosis following acute myocardial infarctionInternational Journal of Cardiology, 2005
- The impact of obesity on the short-term andlong-term outcomes after percutaneous coronary intervention: the obesity paradox?Journal of the American College of Cardiology, 2002
- Low-Normal or Excessive Body Mass Index: Newly Identified and Powerful Risk Factors for Death and Other Complications With Percutaneous Coronary InterventionThe American Journal of Cardiology, 1996