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. 2012 Aug;125(8):796-803.
doi: 10.1016/j.amjmed.2012.01.018. Epub 2012 Apr 5.

Body mass index and mortality in acute myocardial infarction patients

Emily M Bucholz  1 , Saif S Rathore, Kimberly J Reid, Philip G Jones, Paul S Chan, Michael W Rich, John A Spertus, Harlan M Krumholz
Affiliations

Body mass index and mortality in acute myocardial infarction patients

Emily M Bucholz et al. Am J Med. 2012 Aug.

Abstract

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.

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Conflict of interest statement

Conflicts of Interest:

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.

Figures

Figure 1
Figure 1
Kaplan Meier plot showing unadjusted mortality by category of body mass index; p<.001 using the log-rank test for the overall comparison among the groups.
Figure 2
Figure 2
Unadjusted 1-year mortality as a function of body mass index with 95% confidence intervals.
Figure 3
Figure 3
Adjusted 1-year mortality as a function of body mass index with 95% confidence intervals.
See this image and copyright information in PMC

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