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Body mass index, carotid plaque, and clinical outcomes in patients with coronary artery disease

Park, Hyun Woonga; Kim, Ki-Hongb; Song, In Girlb; Kwon, Taek-Geunb; Kim, Wan Hoc; Bae, Jang-Hob

doi: 10.1097/MCA.0000000000000467
Original Research
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Objectives We evaluated the relationship among BMI, carotid sonographic findings, and long-term (5 years) cardiovascular events in Asian patients with coronary artery disease (CAD).

Patients and methods The study population consisted of 1342 consecutive patients with CAD, who were stratified into four groups according to weight status, as defined by the WHO for the Asian population: underweight (group I: BMI<18.5 kg/m2, n=38); normal weight (group II: 18.5≤BMI<23.5 kg/m2, n=352); overweight (group III: 23.5≤BMI<27.5 kg/m2, n=700); and obese (group IV: BMI≥27.5 kg/m2, n=252). All patients underwent carotid ultrasonography. Multivariate analysis was performed to identify predictors of long-term mortality, and the results were expressed in terms of hazard ratio (HR) with 95% confidence interval (95% CI).

Results Compared with the other groups, groups I and II included older patients and had a higher incidence of multivessel CAD, carotid plaque (group I: 42.1%; group II: 42.3%; group III: 27.9%; group IV: 24.6%; P=0.003), and major cardiovascular events including cardiac death, acute myocardial infarction, and stroke. In multivariate analysis, old age, lower ejection fraction, high carotid intima-media thickness, and presence of carotid plaque were positive independent predictors for mortality, whereas BMI was a negative independent predictor (group II: HR=0.28, 95% CI=0.14–0.57, P<0.001; group III: HR=0.26, 95% CI=0.13–0.51, P<0.001; group IV: HR=0.08, 95% CI=0.03–0.22, P<0.001).

Conclusion In patients with CAD, underweight and normal-weight status was associated with higher long-term mortality rates and incidence of major cardiovascular events, suggesting that the obesity paradox is also manifested in Asian patients with CAD.

aDepartment of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju

bDivision of Cardiology, Konyang University Hospital, Daejeon

cDepartment of Cardiology, Andong Sungso Hospital, Andong, South Korea

Correspondence to Jang-Ho Bae, MD, PhD, FACC, Division of Cardiology, College of Medicine, Konyang University Hospital, 685 Gasoowon-dong, Seo-gu, Daejeon, South Korea Tel: +82 426 009 400; fax: +82 426 009 420; e-mail: janghobae@yahoo.co.kr

Received October 31, 2016

Received in revised form December 20, 2016

Accepted December 22, 2016

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