Body Mass Index and Association With Cardiovascular Outcomes in Patients With Stable Coronary Heart Disease – A STABILITY Substudy

Claes Held; Nermin Hadziosmanovic; Philip E. Aylward; Emil Hagström; Judith S. Hochman; Ralph A. H. Stewart; Harvey D. White; Lars Wallentin

doi:10.1161/JAHA.121.023667

Body Mass Index and Association With Cardiovascular Outcomes in Patients With Stable Coronary Heart Disease – A STABILITY Substudy

Claes Held
, Nermin Hadziosmanovic
, Philip E. Aylward
, Emil Hagström
, Judith S. Hochman
, Ralph A. H. Stewart
, Harvey D. White
, Lars Wallentin

College of Medicine and Public Health

Research output: Contribution to journal › Article › peer-review

83 Citations (Scopus)

3 Downloads (Pure)

Abstract

BACKGROUND: The obesity paradox states that patients with higher body mass index (BMI) and cardiovascular disease may experience better prognosis. However, this is less clear in patients with coronary heart disease.

METHODS AND RESULTS: The prospective STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial included 15 828 patients with stable coronary heart disease with 3 to 5 years’ follow-up on optimal secondary preventive treatment. BMI was measured at baseline (n=15 785). Associations between BMI and cardiovascular outcomes were evaluated by Cox regression analyses with multivariable adjustments. Mean age was 64±9 years and 19% women. Most risk markers (diabetes, hypertension, inflammatory biomarkers, triglycerides) showed a graded association with higher BMI. The frequency of smoking, levels of high-density lipoprotein, growth differentiation factor 15, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) were higher at lower BMI. Low BMI (<20 kg/m²; n=244 [1.5%]) was associated with doubled risk of total death (hazard ratio [HR], 2.27; 95% CI, 1.60–3.22), cardiovascular death (HR, 2.26; 95% CI, 1.46–3.49), and heart failure (HR, 2.51; 95% CI, 1.35–4.68) compared with BMI of 25 to <30 kg/m² (n=6752 [42.8%]) as reference. Similarly, high BMI of ≥35 kg/m² (n=1768 [11.2%]) was associated with increased risk of the same outcomes. A BMI between 20 and <25 kg/m² was associated with increased risk of cardiovascular death (HR, 1.26; 95% CI, 1.03–1.54) and total death (HR, 1.21; 95% CI, 1.03–1.42).

CONCLUSIONS: Patients with stable coronary heart disease showed a graded increase in cardiometabolic and inflammatory risk factors with increasing BMI category >25 kg/m². All-cause and cardiovascular mortality were lowest at BMI of 25 to 35 kg/m². Underweight with BMI of <20 kg/m² and very high BMI of ≥35 kg/m² were strong risk markers for poor prognosis.

REGISTRATION: URL: https://clinicaltrials.gov/; Unique identifier NCT00799903.

Original language	English
Article number	e023667
Number of pages	15
Journal	Journal of the American Heart Association
Volume	11
Issue number	3
DOIs	https://doi.org/10.1161/JAHA.121.023667
Publication status	Published - 1 Feb 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

coronary artery disease
obesity
risk factors

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10.1161/JAHA.121.023667Licence: CC BY-NC

Final published versionFinal published version, 1.15 MBLicence: CC BY-NC

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Held, C., Hadziosmanovic, N., Aylward, P. E., Hagström, E., Hochman, J. S., Stewart, R. A. H., White, H. D., & Wallentin, L. (2022). Body Mass Index and Association With Cardiovascular Outcomes in Patients With Stable Coronary Heart Disease – A STABILITY Substudy. Journal of the American Heart Association, 11(3), Article e023667. https://doi.org/10.1161/JAHA.121.023667

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title = "Body Mass Index and Association With Cardiovascular Outcomes in Patients With Stable Coronary Heart Disease – A STABILITY Substudy",

abstract = "BACKGROUND: The obesity paradox states that patients with higher body mass index (BMI) and cardiovascular disease may experience better prognosis. However, this is less clear in patients with coronary heart disease.METHODS AND RESULTS: The prospective STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial included 15 828 patients with stable coronary heart disease with 3 to 5 years{\textquoteright} follow-up on optimal secondary preventive treatment. BMI was measured at baseline (n=15 785). Associations between BMI and cardiovascular outcomes were evaluated by Cox regression analyses with multivariable adjustments. Mean age was 64±9 years and 19\% women. Most risk markers (diabetes, hypertension, inflammatory biomarkers, triglycerides) showed a graded association with higher BMI. The frequency of smoking, levels of high-density lipoprotein, growth differentiation factor 15, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) were higher at lower BMI. Low BMI (<20 kg/m2; n=244 [1.5\%]) was associated with doubled risk of total death (hazard ratio [HR], 2.27; 95\% CI, 1.60–3.22), cardiovascular death (HR, 2.26; 95\% CI, 1.46–3.49), and heart failure (HR, 2.51; 95\% CI, 1.35–4.68) compared with BMI of 25 to <30 kg/m2 (n=6752 [42.8\%]) as reference. Similarly, high BMI of ≥35 kg/m2 (n=1768 [11.2\%]) was associated with increased risk of the same outcomes. A BMI between 20 and <25 kg/m2 was associated with increased risk of cardiovascular death (HR, 1.26; 95\% CI, 1.03–1.54) and total death (HR, 1.21; 95\% CI, 1.03–1.42).CONCLUSIONS: Patients with stable coronary heart disease showed a graded increase in cardiometabolic and inflammatory risk factors with increasing BMI category >25 kg/m2. All-cause and cardiovascular mortality were lowest at BMI of 25 to 35 kg/m2. Underweight with BMI of <20 kg/m2 and very high BMI of ≥35 kg/m2 were strong risk markers for poor prognosis.REGISTRATION: URL: https://clinicaltrials.gov/; Unique identifier NCT00799903.",

keywords = "coronary artery disease, obesity, risk factors",

author = "Claes Held and Nermin Hadziosmanovic and Aylward, \{Philip E.\} and Emil Hagstr{\"o}m and Hochman, \{Judith S.\} and Stewart, \{Ralph A. H.\} and White, \{Harvey D.\} and Lars Wallentin",

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doi = "10.1161/JAHA.121.023667",

language = "English",

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journal = "Journal of the American Heart Association",

issn = "2047-9980",

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T1 - Body Mass Index and Association With Cardiovascular Outcomes in Patients With Stable Coronary Heart Disease – A STABILITY Substudy

AU - Held, Claes

AU - Hadziosmanovic, Nermin

AU - Aylward, Philip E.

AU - Hagström, Emil

AU - Hochman, Judith S.

AU - Stewart, Ralph A. H.

AU - White, Harvey D.

AU - Wallentin, Lars

PY - 2022/2/1

Y1 - 2022/2/1

N2 - BACKGROUND: The obesity paradox states that patients with higher body mass index (BMI) and cardiovascular disease may experience better prognosis. However, this is less clear in patients with coronary heart disease.METHODS AND RESULTS: The prospective STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial included 15 828 patients with stable coronary heart disease with 3 to 5 years’ follow-up on optimal secondary preventive treatment. BMI was measured at baseline (n=15 785). Associations between BMI and cardiovascular outcomes were evaluated by Cox regression analyses with multivariable adjustments. Mean age was 64±9 years and 19% women. Most risk markers (diabetes, hypertension, inflammatory biomarkers, triglycerides) showed a graded association with higher BMI. The frequency of smoking, levels of high-density lipoprotein, growth differentiation factor 15, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) were higher at lower BMI. Low BMI (<20 kg/m2; n=244 [1.5%]) was associated with doubled risk of total death (hazard ratio [HR], 2.27; 95% CI, 1.60–3.22), cardiovascular death (HR, 2.26; 95% CI, 1.46–3.49), and heart failure (HR, 2.51; 95% CI, 1.35–4.68) compared with BMI of 25 to <30 kg/m2 (n=6752 [42.8%]) as reference. Similarly, high BMI of ≥35 kg/m2 (n=1768 [11.2%]) was associated with increased risk of the same outcomes. A BMI between 20 and <25 kg/m2 was associated with increased risk of cardiovascular death (HR, 1.26; 95% CI, 1.03–1.54) and total death (HR, 1.21; 95% CI, 1.03–1.42).CONCLUSIONS: Patients with stable coronary heart disease showed a graded increase in cardiometabolic and inflammatory risk factors with increasing BMI category >25 kg/m2. All-cause and cardiovascular mortality were lowest at BMI of 25 to 35 kg/m2. Underweight with BMI of <20 kg/m2 and very high BMI of ≥35 kg/m2 were strong risk markers for poor prognosis.REGISTRATION: URL: https://clinicaltrials.gov/; Unique identifier NCT00799903.

AB - BACKGROUND: The obesity paradox states that patients with higher body mass index (BMI) and cardiovascular disease may experience better prognosis. However, this is less clear in patients with coronary heart disease.METHODS AND RESULTS: The prospective STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial included 15 828 patients with stable coronary heart disease with 3 to 5 years’ follow-up on optimal secondary preventive treatment. BMI was measured at baseline (n=15 785). Associations between BMI and cardiovascular outcomes were evaluated by Cox regression analyses with multivariable adjustments. Mean age was 64±9 years and 19% women. Most risk markers (diabetes, hypertension, inflammatory biomarkers, triglycerides) showed a graded association with higher BMI. The frequency of smoking, levels of high-density lipoprotein, growth differentiation factor 15, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) were higher at lower BMI. Low BMI (<20 kg/m2; n=244 [1.5%]) was associated with doubled risk of total death (hazard ratio [HR], 2.27; 95% CI, 1.60–3.22), cardiovascular death (HR, 2.26; 95% CI, 1.46–3.49), and heart failure (HR, 2.51; 95% CI, 1.35–4.68) compared with BMI of 25 to <30 kg/m2 (n=6752 [42.8%]) as reference. Similarly, high BMI of ≥35 kg/m2 (n=1768 [11.2%]) was associated with increased risk of the same outcomes. A BMI between 20 and <25 kg/m2 was associated with increased risk of cardiovascular death (HR, 1.26; 95% CI, 1.03–1.54) and total death (HR, 1.21; 95% CI, 1.03–1.42).CONCLUSIONS: Patients with stable coronary heart disease showed a graded increase in cardiometabolic and inflammatory risk factors with increasing BMI category >25 kg/m2. All-cause and cardiovascular mortality were lowest at BMI of 25 to 35 kg/m2. Underweight with BMI of <20 kg/m2 and very high BMI of ≥35 kg/m2 were strong risk markers for poor prognosis.REGISTRATION: URL: https://clinicaltrials.gov/; Unique identifier NCT00799903.

KW - coronary artery disease

KW - obesity

KW - risk factors

UR - https://www.scopus.com/pages/publications/85123969535

U2 - 10.1161/JAHA.121.023667

DO - 10.1161/JAHA.121.023667

M3 - Article

C2 - 35060389

AN - SCOPUS:85123969535

SN - 2047-9980

VL - 11

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 3

M1 - e023667

ER -

Body Mass Index and Association With Cardiovascular Outcomes in Patients With Stable Coronary Heart Disease – A STABILITY Substudy

Abstract

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Keywords

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