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High School Body Mass Index and Body Mass Index at Entry to a Cardiac Disease Risk Prevention Clinic and the Association to All-Cause Mortality and Coronary Heart Disease: A PreCIS Database Study

Gambino, Katherine K. MSN, CRNP; Zumpano, Julia RD; Brennan, Danielle M. MS; Hoogwerf, Byron J. MD

Journal of Cardiovascular Nursing: March-April 2010 - Volume 25 - Issue 2 - p 99-105
doi: 10.1097/JCN.0b013e3181bdbc4c
ARTICLES: Prevention

Objective: To investigate overweight/obese patients (body mass index [BMI], ≥25 kg/m2) at entry to a preventive cardiology clinic who had a high school (HS) BMI of 25 kg/m2 or greater versus those with a BMI of less than 25 kg/m2 to determine coronary heart disease (CHD) prevalence, all-cause mortality.

Methods: Patients (n = 4,597) who had a BMI of 25 kg/m2 or greater at the time of initial visit to the prevention clinic were asked to report their weight at graduation from HS. Patients with BMI of 25 kg/m2 or greater in HS (n = 1,285) were compared with patients (n = 3,312) with a BMI of less than 25 kg/m2 in HS. Prevalent CHD was assessed at entry. Patient mortality was assessed using the Social Security Death Index for a maximum of 7 years after the initial visit.

Results: Mean/median values for most CHD risk factors were higher in the group with an HS BMI of 25 kg/m2 or greater, with the exception of low-density lipoprotein level (120 vs 132 mg/dL; P < .001), Lipoprotein (a) level (16 vs 19 mg/dL; P = .003), and systolic blood pressure (126 vs 128. 3 mm Hg; P < .001). Patients with an HS BMI of 25 kg/m2 or greater had a higher mean BMI at initial visit (33.9 vs 30.1; P < .001) and hemoglobin A1c (6.8% vs 6.3%; P < .001) and glucose concentrations (93 vs 91 mg/dL; P = .004), with a lower mean high-density lipoprotein level (43.2 vs 46.5 mg/dL; P < .001) as well as greater prevalence of smoking (16.2% vs 11.4%; P < .001), diabetes mellitus (32.4% vs 21.8%; P < .001), CHD (47.1% vs 43%; P = .01), and specifically myocardial infarction (25.8% vs 21.1%; P = .001). Fibrinogen and urine albumin-to-creatinine levels were elevated. After adjusting for risk factors, an HS BMI of 25 kg/m2 or greater was associated with a 21% higher prevalence of CHD (odds ratio, 1.20; P = .027). However, an HS BMI of 25 kg/m2 or greater was not a significant predictor of 7-year mortality (hazard ratio, 1.03; P = .84).

Conclusion: Patients with an HS BMI of 25 kg/m2 or greater had more CHD risk factors compared with those with an HS BMI of less than 25 kg/m2. Prevalence of CHD was also significantly higher in this group. However, an HS BMI of 25 kg/m2 or greater was not a significant predictor of mortality.

Katherine K. Gambino, MSN, CRNP Nurse Practitioner, Preventive Cardiology and Rehabilitation and Nurse Manager, Women's Cardiovascular Center, Cleveland Clinic, Ohio.

Julia Zumpano, RD Registered Dietician, Preventive Cardiology and Rehabilitation and Women's Cardiovascular Center, Cleveland Clinic, Ohio.

Danielle M. Brennan, MS Senior Biostatistician, Department of Cardiovascular Medicine, Cleveland Clinic, Ohio.

Byron J. Hoogwerf, MD Staff Emeritus, Preventive Cardiology and Rehabilitation and Women's Cardiovascular Center, Cleveland Clinic; Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Ohio.

Corresponding author Katherine K. Gambino, MSN, CRNP, Cleveland Clinic, Preventive Cardiology and Rehabilitation, Desk Jb1, 9500 Euclid Ave, Cleveland, OH 44195 (gambink@ccf.org).

© 2010 Lippincott Williams & Wilkins, Inc.