The influence of optimal medical treatment on the 'obesity paradox', body mass index and long-term mortality in patients treated with percutaneous coronary intervention: a prospective cohort study. Issue 1 (9th February 2012)

• Record Type: Journal Article
• Authors: Schenkeveld, Lisanne; Magro, Michael; Oemrawsingh, Rohit M; Lenzen, Mattie; de Jaegere, Peter; van Geuns, Robert-Jan; Serruys, Patrick W; van Domburg, Ron T
• Is Part Of: BMJ open. Volume 2:Issue 1(2012)
• Publication Date: 2012-02-09
• Subjects: Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2011-000535
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To assess whether the obesity paradox persists in the long term and to study the effect of optimal medical treatment on this phenomenon. Design: A retrospective cohort study. Setting: A tertiary care centre in Rotterdam. Participants: From January 2000 to December 2005, 6332 patients undergoing percutaneous coronary intervention for coronary artery disease were categorised into underweight (body mass index (BMI)<18.5), normal (18.5–24.9), overweight (25–29.9) and obese (>30). Primary outcome measure: Mortality. Secondary outcome measures: Cardiac death and non-fatal myocardial infarction. Results: Optimal medical treatment was more common in obese patients as compared with normal weight patients (85% vs 76%; p<0.001). At a mean of 6.1 years, overweight and obese patients had a lower risk of all-cause mortality (HR: 0.75, 95% CI 0.66 to 0.86 and HR: 0.72, 95% CI 0.60 to 0.87, respectively). After adjusting for OMT in the multivariate analysis, BMI did not remain an independent predictor of long-term mortality (HR: 0.90, 95% CI 0.72 to 1.12 and HR: 1.07, 95% CI: 0.80 to 1.43, respectively). Conclusion: BMI is inversely related to long-term mortality in patients treated with percutaneous coronary intervention. Patients with a normal BMI are on suboptimal medical treatment when compared with those with a high BMI. A more optimal medical treatment in the obese group may explain the observed improved outcome in these patients.