Coronary artery disease
Relation of Body Fat Categories by Gallagher Classification and by Continuous Variables to Mortality in Patients With Coronary Heart Disease

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Although obesity is a coronary heart disease risk factor, in cohorts of patients with coronary heart disease, an “obesity paradox” exists whereby patients with obesity have a better prognosis than do leaner patients. Obesity is generally defined by body mass index, with relatively little described regarding body fat (BF). In this study, 581 consecutive patients with coronary heart disease divided into the Gallagher BF categories of underweight (n = 12), normal (n = 189), overweight (n = 214), and obese (n = 166) were evaluated, and 3-year mortality was assessed using the National Death Index. Mortality was U shaped, being highest in the underweight group (25%, p <0.0001 vs all groups) and lowest in the overweight group (2.3%), with intermediate mortality in the normal-BF (6.4%, p = 0.02 vs overweight) and obese (3.6%) groups. In multiple regression analysis, high BF (odds ratio 0.89, 95% confidence interval 0.82 to 0.95) and higher Gallagher class (odds ratio 0.46, 95% confidence interval 0.25 to 0.84) were independent predictors of lower mortality. In conclusion, on the basis of Gallagher BF, an obesity paradox exists, with the highest mortality in the underweight and normal-BF groups and the lowest mortality in the overweight group. Lower BF as a continuous variable and by Gallagher classification as a categorical value were independent predictors of higher mortality.

Section snippets

Methods

We retrospectively reviewed the records of 622 consecutive patients with stable CHD who were referred for potential entry into phase 2 cardiac rehabilitation and exercise programs from January 1, 2000 to July 31, 2005, who had baseline anthropometric, lipid, and clinical data, as we have previously described6, 7, 8, 9 (41 patients were excluded because of incomplete data). The subjects were referred after coronary artery bypass graft surgery (33%), myocardial infarctions (21%), and/or a

Results

Baseline characteristics of the subject population and of the 4 distinct Gallagher BF groups are listed in Table 2, which demonstrates that our population was overall overweight or obese as determined by either BMI or BF. The groups differed in age, peak oxygen consumption, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting glucose. The underweight group contained significantly more women, and underweight patients more often had histories of hypertension and

Discussion

These data confirm the presence of an obesity paradox using subcutaneous BF in a cohort of patients with CHD. For the first time, this obesity paradox was demonstrated using the Gallagher classification of BF, with highest mortality noted in the underweight and normal-BF groups and the lowest mortality in the overweight group.

Numerous studies have demonstrated that once cardiovascular (CV) diseases, including CHD, become established, the overweight and obese seem to have a better prognosis than

Disclosures

The authors have no conflicts of interest to disclose.

References (28)

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