Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data

TY - JOUR

T1 - Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data

AU - Coutinho, Thais

AU - Goel, Kashish

AU - Corrêa de Sá, Daniel

AU - Kragelund, Charlotte

AU - Kanaya, Alka M

AU - Zeller, Marianne

AU - Park, Jong-Seon

AU - Kober, Lars

AU - Torp-Pedersen, Christian

AU - Cottin, Yves

AU - Lorgis, Luc

AU - Lee, Sang-Hee

AU - Kim, Young-Jo

AU - Thomas, Randal

AU - Roger, Véronique L

AU - Somers, Virend K

AU - Lopez-Jimenez, Francisco

N1 - Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2011/5/10

Y1 - 2011/5/10

N2 - Objectives: The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients. Background: The question of which measure of obesity better predicts survival in patients with CAD is controversial. Methods: We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months. Results: From 2,188 studies found, 6 met inclusion criteria. We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort. A variable called "central obesity" was created on the basis of tertiles of WHR or WC. Cox-proportional hazards were adjusted for age, sex, and confounders. The final sample consisted of 15,923 subjects. There were 5,696 deaths after a median follow-up of 2.3 (interquartile range 0.5 to 7.4) years. Central obesity was associated with mortality (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.58 to 1.83), whereas BMI was inversely associated with mortality (HR: 0.64, 95% CI: 0.59 to 0.69). Central obesity was also associated with higher mortality in the subset of subjects with normal BMI (HR: 1.70, 95% CI: 1.52 to 1.89) and BMI <30 kg/m 2 (HR: 1.93, 95% CI: 1.61 to 2.32). Conclusions: In subjects with CAD, including those with normal and high BMI, central obesity but not BMI is directly associated with mortality.

AB - Objectives: The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients. Background: The question of which measure of obesity better predicts survival in patients with CAD is controversial. Methods: We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months. Results: From 2,188 studies found, 6 met inclusion criteria. We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort. A variable called "central obesity" was created on the basis of tertiles of WHR or WC. Cox-proportional hazards were adjusted for age, sex, and confounders. The final sample consisted of 15,923 subjects. There were 5,696 deaths after a median follow-up of 2.3 (interquartile range 0.5 to 7.4) years. Central obesity was associated with mortality (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.58 to 1.83), whereas BMI was inversely associated with mortality (HR: 0.64, 95% CI: 0.59 to 0.69). Central obesity was also associated with higher mortality in the subset of subjects with normal BMI (HR: 1.70, 95% CI: 1.52 to 1.89) and BMI <30 kg/m 2 (HR: 1.93, 95% CI: 1.61 to 2.32). Conclusions: In subjects with CAD, including those with normal and high BMI, central obesity but not BMI is directly associated with mortality.

U2 - http://dx.doi.org/10.1016/j.jacc.2010.11.058

DO - http://dx.doi.org/10.1016/j.jacc.2010.11.058

M3 - Journal article

SN - 0735-1097

VL - 57

SP - 1877

EP - 1886

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 19

ER -