Coronary artery disease
Medical Therapies and Invasive Treatments for Coronary Artery Disease by Body Mass: The “Obesity Paradox” in the Get With The Guidelines Database

https://doi.org/10.1016/j.amjcard.2007.06.019Get rights and content

Previous studies of hospitalized patients have suggested an “obesity paradox” with lower short-term mortality as weight increases. We hypothesized that some of this difference might be related to more aggressive management. To evaluate the effect of body mass index (BMI) on treatments and outcomes in patients with coronary artery disease (CAD), the Get With The Guidelines database was investigated. From 409 United States hospitals, 130,139 hospitalizations for CAD were identified with documented height and weight. Patients were stratified by BMI, with 3,305 (2.5%) underweight (BMI <18.5 kg/m2), 34,697 (27%) of healthy weight (BMI 18.5 to 24.9 kg/m2), 47,883 (37%) overweight (BMI 25 to 29.9 kg/m2), 37,686 (29%) obese (BMI 30 to 39.9 kg/m2), and 6,568 (5%) extremely obese (BMI ≥40 kg/m2). As BMI increased, patients were significantly younger but more likely to be men and have hypertension, diabetes, and hyperlipidemia. Unadjusted in-hospital mortality was highest in the underweight group (10.4%) and significantly lower in the healthy-weight (5.4%), overweight (3.1%), obese (2.4%), and extremely obese (2.9%) patients. Higher BMI was associated with increased use of standard medical therapies such as aspirin, β blockers, inhibitors of the renin-angiotensin system, and lipid-lowering therapy in the hospital and at discharge. In adjusted analyses, compared with the healthy-weight group, overweight and obese patients were more likely to undergo invasive procedures and had lower mortality (p <0.01 for all odds ratios). In conclusion, increasing BMI appears to be associated with better use of guideline-recommended medical treatment and invasive management of CAD, which may explain the observed lower rates of in-hospital mortality.

Section snippets

Methods and Results

The GWTG initiative has been previously described.9 Briefly, it is a national cardiovascular quality improvement project, using a point-of-service, interactive, Internet-based Patient Management Tool (Outcome, Cambridge, Massachusetts). The CAD section of GWTG includes patients hospitalized for the entire spectrum of CAD: known CAD, unstable angina, non–ST-elevation myocardial infarction, ST-elevation myocardial infarction, or acute myocardial infarction, unspecified. All patients with these

Discussion

In this cohort of >130,000 hospitalizations for CAD, obesity was associated with development of premature CAD because patients with increased BMI presented with CAD at a significantly younger age. However, in these patients hospitalized with CAD, higher BMI was not associated with an increased mortality risk even after adjustment for multiple factors of prognostic significance. It also appears that increased body mass is associated with greater use of guideline-recommended therapies on

References (20)

There are more references available in the full text version of this article.

Cited by (0)

The Get With The Guidelines (GWTG)—Coronary Artery Disease initiative is supported by an unrestricted educational grant from the Merck/Schering-Plough Pharmaceutical Partnership. The Duke Clinical Research Institute (Durham, North Carolina) receives funding from the American Heart Association as the GWTG analysis center. Dr. Cannon currently receives research grant support from Accumetrics, San Diego, California; AstraZeneca, Wilmington, Delaware; Merck, Whitehouse Station, New Jersey; Merck/Schering Plough Partnership, and Schering Plough, Kenilworth, New Jersey. Dr. Peterson has received research grant support from Schering Plough, Bristol-Myers Squibb, New York, New York; Sanofi-Aventis, Bridgewater, New Jersey, and Merck Schering. Dr. Fonarow has received research grants from GlaxoSmithKline, Philadelphia, Pennsylvania; Pfizer, New York, New York; and Amgen, Thousand Oaks, California.

View full text