Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease: Role of “Normal Weight Central Obesity”

Thais Coutinho; Kashish Goel; Daniel Corrêa de Sá; Rickey E Carter; David O Hodge; 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:10.1016/j.jacc.2012.10.035

Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease: Role of “Normal Weight Central Obesity”

Thais Coutinho, Kashish Goel, Daniel Corrêa de Sá, Rickey E Carter, David O Hodge, 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

168 Citations (Scopus)

Abstract

Objectives: This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based on a combination of body mass index (BMI) and measures of central obesity. Background: In CAD patients, mortality has been reported to vary inversely with BMI ("obesity paradox"). In contrast, central obesity is directly associated with mortality. Because of this bi-directional relationship, we hypothesized that CAD patients with normal BMI but with central obesity would have worse survival compared with subjects with other combinations of BMI and central adiposity. Methods: We included 15,547 participants with CAD who took part in 5 studies from 3 continents. Multivariate stratified Cox-proportional hazard models that adjusted for potential confounders were used to assess mortality risk according to different patterns of adiposity that combined BMI with measures of central obesity. Results: Mean age was 66 years; 55% were men. There were 4,699 deaths over a median follow-up of 4.7 years. Subjects with normal weight but central obesity had the worst long-term survival: a person with BMI of 22 kg/m² and waist-to-hip ratio (WHR) of 0.98 had higher mortality than a person with similar BMI but WHR of 0.89 (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.05 to 1.17); than a person with BMI of 26 kg/m² and WHR of 0.89 (HR: 1.20; 95% CI: 1.09 to 1.31), than in a person with BMI of 30 kg/m² and WHR of 0.89 (HR: 1.61; 95% CI: 1.39 to 1.86), and than a person with BMI of 30 kg/m ² and WHR of 0.98 (HR: 1.27; 95% CI: 1.18 to 1.39) (p < 0.0001 for all). Conclusions: In patients with CAD, normal weight with central obesity was associated with the highest risk of mortality.

Original language	English
Journal	Journal of the American College of Cardiology
Volume	61
Issue number	5
Pages (from-to)	553-60
Number of pages	8
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2012.10.035
Publication status	Published - 5 Feb 2013

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Coutinho, T., Goel, K., Corrêa de Sá, D., Carter, R. E., Hodge, D. O., 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. (2013). Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease: Role of “Normal Weight Central Obesity”. Journal of the American College of Cardiology, 61(5), 553-60. https://doi.org/10.1016/j.jacc.2012.10.035

Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease : Role of “Normal Weight Central Obesity”. / Coutinho, Thais; Goel, Kashish; Corrêa de Sá, Daniel et al.

In: Journal of the American College of Cardiology, Vol. 61, No. 5, 05.02.2013, p. 553-60.

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

Coutinho, T, Goel, K, Corrêa de Sá, D, Carter, RE, Hodge, DO, Kragelund, C, Kanaya, AM, Zeller, M, Park, JS, Kober, L , Torp-Pedersen, C, Cottin, Y, Lorgis, L, Lee, S-H, Kim, Y-J, Thomas, R, Roger, VL, Somers, VK & Lopez-Jimenez, F 2013, 'Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease: Role of “Normal Weight Central Obesity”', Journal of the American College of Cardiology, vol. 61, no. 5, pp. 553-60. https://doi.org/10.1016/j.jacc.2012.10.035

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title = "Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease: Role of “Normal Weight Central Obesity”",

abstract = "Objectives: This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based on a combination of body mass index (BMI) and measures of central obesity. Background: In CAD patients, mortality has been reported to vary inversely with BMI ({"}obesity paradox{"}). In contrast, central obesity is directly associated with mortality. Because of this bi-directional relationship, we hypothesized that CAD patients with normal BMI but with central obesity would have worse survival compared with subjects with other combinations of BMI and central adiposity. Methods: We included 15,547 participants with CAD who took part in 5 studies from 3 continents. Multivariate stratified Cox-proportional hazard models that adjusted for potential confounders were used to assess mortality risk according to different patterns of adiposity that combined BMI with measures of central obesity. Results: Mean age was 66 years; 55% were men. There were 4,699 deaths over a median follow-up of 4.7 years. Subjects with normal weight but central obesity had the worst long-term survival: a person with BMI of 22 kg/m2 and waist-to-hip ratio (WHR) of 0.98 had higher mortality than a person with similar BMI but WHR of 0.89 (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.05 to 1.17); than a person with BMI of 26 kg/m2 and WHR of 0.89 (HR: 1.20; 95% CI: 1.09 to 1.31), than in a person with BMI of 30 kg/m2 and WHR of 0.89 (HR: 1.61; 95% CI: 1.39 to 1.86), and than a person with BMI of 30 kg/m 2 and WHR of 0.98 (HR: 1.27; 95% CI: 1.18 to 1.39) (p < 0.0001 for all). Conclusions: In patients with CAD, normal weight with central obesity was associated with the highest risk of mortality.",

author = "Thais Coutinho and Kashish Goel and {Corr{\^e}a de S{\'a}}, Daniel and Carter, {Rickey E} and Hodge, {David O} and Charlotte Kragelund and Kanaya, {Alka M} and Marianne Zeller and Park, {Jong Seon} 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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doi = "10.1016/j.jacc.2012.10.035",

language = "English",

volume = "61",

pages = "553--60",

journal = "Journal of the American College of Cardiology",

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T1 - Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease

T2 - Role of “Normal Weight Central Obesity”

AU - Coutinho, Thais

AU - Goel, Kashish

AU - Corrêa de Sá, Daniel

AU - Carter, Rickey E

AU - Hodge, David O

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 - 2013/2/5

Y1 - 2013/2/5

N2 - Objectives: This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based on a combination of body mass index (BMI) and measures of central obesity. Background: In CAD patients, mortality has been reported to vary inversely with BMI ("obesity paradox"). In contrast, central obesity is directly associated with mortality. Because of this bi-directional relationship, we hypothesized that CAD patients with normal BMI but with central obesity would have worse survival compared with subjects with other combinations of BMI and central adiposity. Methods: We included 15,547 participants with CAD who took part in 5 studies from 3 continents. Multivariate stratified Cox-proportional hazard models that adjusted for potential confounders were used to assess mortality risk according to different patterns of adiposity that combined BMI with measures of central obesity. Results: Mean age was 66 years; 55% were men. There were 4,699 deaths over a median follow-up of 4.7 years. Subjects with normal weight but central obesity had the worst long-term survival: a person with BMI of 22 kg/m2 and waist-to-hip ratio (WHR) of 0.98 had higher mortality than a person with similar BMI but WHR of 0.89 (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.05 to 1.17); than a person with BMI of 26 kg/m2 and WHR of 0.89 (HR: 1.20; 95% CI: 1.09 to 1.31), than in a person with BMI of 30 kg/m2 and WHR of 0.89 (HR: 1.61; 95% CI: 1.39 to 1.86), and than a person with BMI of 30 kg/m 2 and WHR of 0.98 (HR: 1.27; 95% CI: 1.18 to 1.39) (p < 0.0001 for all). Conclusions: In patients with CAD, normal weight with central obesity was associated with the highest risk of mortality.

AB - Objectives: This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based on a combination of body mass index (BMI) and measures of central obesity. Background: In CAD patients, mortality has been reported to vary inversely with BMI ("obesity paradox"). In contrast, central obesity is directly associated with mortality. Because of this bi-directional relationship, we hypothesized that CAD patients with normal BMI but with central obesity would have worse survival compared with subjects with other combinations of BMI and central adiposity. Methods: We included 15,547 participants with CAD who took part in 5 studies from 3 continents. Multivariate stratified Cox-proportional hazard models that adjusted for potential confounders were used to assess mortality risk according to different patterns of adiposity that combined BMI with measures of central obesity. Results: Mean age was 66 years; 55% were men. There were 4,699 deaths over a median follow-up of 4.7 years. Subjects with normal weight but central obesity had the worst long-term survival: a person with BMI of 22 kg/m2 and waist-to-hip ratio (WHR) of 0.98 had higher mortality than a person with similar BMI but WHR of 0.89 (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.05 to 1.17); than a person with BMI of 26 kg/m2 and WHR of 0.89 (HR: 1.20; 95% CI: 1.09 to 1.31), than in a person with BMI of 30 kg/m2 and WHR of 0.89 (HR: 1.61; 95% CI: 1.39 to 1.86), and than a person with BMI of 30 kg/m 2 and WHR of 0.98 (HR: 1.27; 95% CI: 1.18 to 1.39) (p < 0.0001 for all). Conclusions: In patients with CAD, normal weight with central obesity was associated with the highest risk of mortality.

U2 - 10.1016/j.jacc.2012.10.035

DO - 10.1016/j.jacc.2012.10.035

M3 - Journal article

C2 - 23369419

SN - 0735-1097

VL - 61

SP - 553

EP - 560

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 5

ER -

Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease: Role of “Normal Weight Central Obesity”

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