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. 2015 Aug 26;7(2):12-18.
doi: 10.1136/heartasia-2015-010644. eCollection 2015.

Lean body mass index prognostic value for cardiovascular events in patients with coronary artery disease

Hirofumi Hioki  1 , Takashi Miura  1 , Hirohiko Motoki  1 , Hideki Kobayashi  2 , Masanori Kobayashi  3 , Hiroyuki Nakajima  4 , Hikaru Kimura  5 , Eiichiro Mawatari  5 , Hiroshi Akanuma  6 , Toshio Sato  7 , Souichirou Ebisawa  1 , Yusuke Miyashita  1 , Uichi Ikeda  1 ; SHINANO registry investigators; Shoji Hotta  1 , Yuichi Kamiyoshi  1 , Takuya Maruyama  1 , Noboru Watanabe  1 , Takayuki Eisawa  1 , Shinichi Aso  1 , Shinichirou Uchikawa  1 , Naoto Hashizume  1 , Noriyuki Sekimura  1 , Takehiro Morita  1
Affiliations

Lean body mass index prognostic value for cardiovascular events in patients with coronary artery disease

Hirofumi Hioki et al. Heart Asia. .

Abstract

Objective: Little is known about the relationship between body composition indicators, including body mass index (BMI), fat mass index (FMI) and lean BMI (LBMI), and adverse outcomes after percutaneous coronary intervention (PCI) in Asian populations. The aim of this study was to clarify this relationship.

Methods: The SHINANO registry is a prospective, observational, multicenter cohort registry that enrolled 1923 consecutive patients with coronary heart disease (CHD) from August 2012 to July 2013; 66 patients were excluded because of missing data. We evaluated 1857 patients with CHD who underwent PCI (aged 70±11 years; 23% women; BMI 23.8±3.5 kg/m2; LBMI 18.3±1.8 kg/m2; FMI 5.4±2.2 kg/m2). Patients were divided into three groups, based on BMI, LBMI and FMI tertiles, to assess the prognostic value of the three indicators. The primary endpoint was major adverse cardiac events (MACE), including all cause death, non-fatal myocardial infarction and ischaemic stroke at 1 year.

Results: Over a 1 year follow-up period (1776 patients, 95.6%), the cumulative MACE incidence was 8.7% (161 cases). Using Kaplan-Meier analysis, the MACE incidence was significantly higher in patients with lower BMI values (13.4-22.2 kg/m2) (p=0.002) and lower LBMI values (11.6-17.6 kg/m2) (p<0.001); this trend was not observed for FMI. Multivariate Cox regression analysis showed that lower LBMI but not lower BMI values were predictive of a higher MACE incidence (HR 1.55; 95% CI 1.05 to 2.30).

Conclusions: Lower LBMI values are associated with adverse outcomes in an Asian population with CHD undergoing PCI. LBMI is a better predictor of MACE than BMI or FMI.

Clinical trial registration: UMIN-ID; 000010070.

Keywords: CORONARY ARTERY DISEASE.

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Figures

Figure 1
Figure 1
Cumulative incidence of major adverse cardiovascular events (MACE) according to body mass index (BMI), fat mass index (FMI) and lean BMI (LBMI) tertiles. Patients with a BMI of 13.4–22.2 kg/m2 and a LBMI of 11.7–17.6 kg/m2 had a significantly higher incidence of MACE compared with patients having other BMI and LBMI values (χ2 test for linear trend p=0.003 and p<0.001, respectively).
Figure 2
Figure 2
Incidence of clinical events according to lean body mass index (LBMI) tertile. Patients with a LBMI of 11.7–17.6 kg/m2 had a significantly higher incidence of cardiac and non-cardiac deaths compared with those with intermediate or high LBMI values (χ2 test for linear trend p=0.023 and p<0.001, respectively). MI, myocardial infarction.
Figure 3
Figure 3
Kaplan–Meier analysis of major adverse cardiovascular events (MACE) stratified by lean body mass index (LBMI) tertile. Patients with a LBMI of 11.7–17.6 kg/m2 had a significantly higher incidence of MACE than those with intermediate (17.7–19.1 kg/m2) or high (19.2–23.6 kg/m2) LBMI values (12.9% vs 6.6% vs 5.8%, log rank p<0.001).
Figure 4
Figure 4
Kaplan–Meier analysis of major adverse cardiovascular events (MACE) stratified by body mass index (BMI) tertile. Patients with a BMI of 13.4–22.2 kg/m2 had a significantly higher incidence of MACE than those with intermediate (22.3–24.9 kg/m2) or high (25.0–40.8 kg/m2) BMI values (11.6% vs 6.6% vs 7.2%, log rank p=0.002).
Figure 5
Figure 5
Kaplan–Meier analysis of major adverse cardiovascular events (MACE) stratified by fat mass index (FMI) tertile. There were no significant differences in MACE across patients with low (1.12–4.38 kg/m2), intermediate (4.39–5.86 kg/m2) or high (5.87–21.8 kg/m2) FMI values (10.0% vs 7.3% vs 8.2%, log rank p=0.211).
Figure 6
Figure 6
Kaplan–Meier analysis according to major adverse cardiovascular events (MACE) stratified by lean body mass index (LBMI) tertile in patients with a normal body mass index. Patients with a low LBMI (11.7–17.6 kg/m2) had a significantly higher incidence of MACE than those with intermediate (17.7–19.1 kg/m2) or high (19.2–23.6 kg/m2) LBMI values (12.6% vs 5.6% vs 3.4%, log rank p<0.001).
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