Overweight and obese cardiac patients have better prognosis despite reporting worse perceived health and more conventional risk factors

Abstract

Objective: The obesity paradox in patients with cardiovascular disease (CVD) remains unexplained. We examined the role of self-rated health, behavioral and objectively assessed risk factors, in order to further explore mechanisms that might influence the association between body mass index (BMI) and mortality in CVD patients.

Methods: Participants were 4417 community dwelling adults from the Health Survey for England and Scottish Health Survey from 1994-2004 (aged 65.9 ±[Standard deviation (SD) 10.6 yrs], 56.2% men) with clinically diagnosed CVD at baseline.

Results: There were 570 CVD and 1441 and all-cause deaths, over an average of 7.3 yrs of follow-up. Overweight and obese patients reported worse self-rated health, more co-morbidities and biological risk factors. However, compared with non-obese participants (BMI<25 kg/m(2)), a lower risk of all-cause mortality was observed in overweight (BMI 25<30 kg/m(2)) (Hazard ratio [HR]=0.73, 95% confidence intervals [CI], 0.64-0.82), and obese (BMI ≥ 30 kg/m(2)) participants (HR=0.84, 95% CI, 0.73-0.97) after adjustment for age, sex, smoking, physical activity, and various co-morbidities.

Conclusions: Overweight and obese CVD patients have better prognosis despite reporting worse health, more co-morbidities and risk factors, and poorer adherence to lifestyle advice.