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

Thais Coutinho; Kashish Goel; Daniel Corrêa de Sá; Charlotte Kragelund; Alka M Kanaya; Marianne Zeller; Jong-Seon Park; Lars Kober; Christian Torp-Pedersen; Yves Cottin; Luc Lorgis; Sang-Hee Lee; Young-Jo Kim; Randal Thomas; Véronique L Roger; Virend K Somers; Francisco Lopez-Jimenez

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

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

Thais Coutinho, Kashish Goel, Daniel Corrêa de Sá, Charlotte Kragelund, Alka M Kanaya, Marianne Zeller, Jong-Seon Park, Lars Kober, Christian Torp-Pedersen, Yves Cottin, Luc Lorgis, Sang-Hee Lee, Young-Jo Kim, Randal Thomas, Véronique L Roger, Virend K Somers, Francisco Lopez-Jimenez

228 Citations (Scopus)

Abstract

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We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6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 We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort.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.

Original language	English
Journal	Journal of the American College of Cardiology
Volume	57
Issue number	19
Pages (from-to)	1877-86
Number of pages	10
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2010.11.058
Publication status	Published - 10 May 2011

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Coutinho, T., Goel, K., Corrêa de Sá, D., Kragelund, C., Kanaya, A. M., Zeller, M., Park, J-S., Kober, L., Torp-Pedersen, C., Cottin, Y., Lorgis, L., Lee, S-H., Kim, Y-J., Thomas, R., Roger, V. L., Somers, V. K., & Lopez-Jimenez, F. (2011). Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data. Journal of the American College of Cardiology, 57(19), 1877-86. https://doi.org/10.1016/j.jacc.2010.11.058

Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data. / Coutinho, Thais; Goel, Kashish; Corrêa de Sá, Daniel et al.

In: Journal of the American College of Cardiology, Vol. 57, No. 19, 10.05.2011, p. 1877-86.

Research output: Contribution to journal › Journal article › Research › peer-review

Coutinho, T, Goel, K, Corrêa de Sá, D, Kragelund, C, Kanaya, AM, Zeller, M, Park, J-S, Kober, L , Torp-Pedersen, C, Cottin, Y, Lorgis, L, Lee, S-H, Kim, Y-J, Thomas, R, Roger, VL, Somers, VK & Lopez-Jimenez, F 2011, 'Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data', Journal of the American College of Cardiology, vol. 57, no. 19, pp. 1877-86. https://doi.org/10.1016/j.jacc.2010.11.058

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

abstract = " 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.",

author = "Thais Coutinho and Kashish Goel and {Corr{\^e}a de S{\'a}}, Daniel and Charlotte Kragelund and Kanaya, {Alka M} and Marianne Zeller and Jong-Seon Park and Lars Kober and Christian Torp-Pedersen and Yves Cottin and Luc Lorgis and Sang-Hee Lee and Young-Jo Kim and Randal Thomas and Roger, {V{\'e}ronique L} and Somers, {Virend K} and Francisco Lopez-Jimenez",

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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

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 -

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

Abstract

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