TY - JOUR
T1 - Body mass index and mortality in acute myocardial infarction patients
AU - Bucholz, Emily M.
AU - Rathore, Saif S.
AU - Reid, Kimberly J.
AU - Jones, Philip G.
AU - Chan, Paul S.
AU - Rich, Michael W.
AU - Spertus, John A.
AU - Krumholz, Harlan M.
N1 - Funding Information:
Funding: Dr Krumholz is supported by grant U01 HL105270-02 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute . Dr Spertus is supported by grant P50 HL077113 from the National Heart, Lung, and Blood Institute .
Funding Information:
Conflict of Interest: There was no sponsor involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr Krumholz discloses that he chairs a cardiac scientific advisory board for UnitedHealth and is the recipient of a research grant from Medtronic, Inc. through Yale University. Dr Spertus discloses that he serves as a consultant for UnitedHealth. Ms Bucholz, Mr Rathore, Ms Reid, Mr Jones, Dr Chan, and Dr Rich have no conflicts of interest to disclose.
PY - 2012/8
Y1 - 2012/8
N2 - Background: Previous studies have described an "obesity paradox" with heart failure, whereby higher body mass index (BMI) is associated with lower mortality. However, little is known about the impact of obesity on survival after acute myocardial infarction. Methods: Data from 2 registries of patients hospitalized in the US with acute myocardial infarction between 2003-2004 (PREMIER) and 2005-2008 (TRIUMPH) were used to examine the association of BMI with mortality. Patients (n = 6359) were categorized into BMI groups (kg/m 2) using baseline measurements. Two sets of analyses were performed using Cox proportional hazards regression with fractional polynomials to model BMI as categorical and continuous variables. To assess the independent association of BMI with mortality, analyses were repeated, adjusting for 7 domains of patient and clinical characteristics. Results: Median BMI was 28.6. BMI was inversely associated with crude 1-year mortality (normal, 9.2%; overweight, 6.1%; obese, 4.7%; morbidly obese; 4.6%; P <.001), which persisted after multivariable adjustment. When BMI was examined as a continuous variable, the hazards curve declined with increasing BMI and then increased above a BMI of 40. Compared with patients with a BMI of 18.5, patients with higher BMIs had a 20% to 68% lower mortality at 1 year. No interactions between age (P =.37), sex (P =.87), or diabetes mellitus (P =.55) were observed. Conclusions: There appears to be an "obesity paradox" among patients after acute myocardial infarction such that higher BMI is associated with lower mortality, an effect that was not modified by patient characteristics and was comparable across age, sex, and diabetes subgroups.
AB - Background: Previous studies have described an "obesity paradox" with heart failure, whereby higher body mass index (BMI) is associated with lower mortality. However, little is known about the impact of obesity on survival after acute myocardial infarction. Methods: Data from 2 registries of patients hospitalized in the US with acute myocardial infarction between 2003-2004 (PREMIER) and 2005-2008 (TRIUMPH) were used to examine the association of BMI with mortality. Patients (n = 6359) were categorized into BMI groups (kg/m 2) using baseline measurements. Two sets of analyses were performed using Cox proportional hazards regression with fractional polynomials to model BMI as categorical and continuous variables. To assess the independent association of BMI with mortality, analyses were repeated, adjusting for 7 domains of patient and clinical characteristics. Results: Median BMI was 28.6. BMI was inversely associated with crude 1-year mortality (normal, 9.2%; overweight, 6.1%; obese, 4.7%; morbidly obese; 4.6%; P <.001), which persisted after multivariable adjustment. When BMI was examined as a continuous variable, the hazards curve declined with increasing BMI and then increased above a BMI of 40. Compared with patients with a BMI of 18.5, patients with higher BMIs had a 20% to 68% lower mortality at 1 year. No interactions between age (P =.37), sex (P =.87), or diabetes mellitus (P =.55) were observed. Conclusions: There appears to be an "obesity paradox" among patients after acute myocardial infarction such that higher BMI is associated with lower mortality, an effect that was not modified by patient characteristics and was comparable across age, sex, and diabetes subgroups.
KW - Body mass index
KW - Fractional polynomials
KW - Mortality
KW - Myocardial infarction
KW - Obesity paradox
UR - http://www.scopus.com/inward/record.url?scp=84864278918&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2012.01.018
DO - 10.1016/j.amjmed.2012.01.018
M3 - Article
C2 - 22483510
AN - SCOPUS:84864278918
SN - 0002-9343
VL - 125
SP - 796
EP - 803
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 8
ER -