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BMJ Open. 2012 Feb 9;2:e000535. doi: 10.1136/bmjopen-2011-000535. Print 2012.

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.

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  • 1Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.

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.

PMID:
22327630
[PubMed]
PMCID:
PMC3277907
Free PMC Article

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