Romero-Corral A, Montori VM, Somers VK, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: A systematic review of cohort studies
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN 55905, USA. The Lancet
(Impact Factor: 45.22).
08/2006; 368(9536):666-78. DOI: 10.1016/S0140-6736(06)69251-9
Studies of the association between obesity, and total mortality and cardiovascular events in patients with coronary artery disease (CAD) have shown contradictory results. We undertook a systematic review to determine the extent and nature of this association.
We selected cohort studies that provided risk estimates for total mortality, with or without cardiovascular events, on the basis of bodyweight or obesity measures in patients with CAD, and with at least 6 months' follow-up. CAD was defined as history of percutaneous coronary intervention, coronary artery bypass graft, or myocardial infarction. We obtained risk estimates for five predetermined bodyweight groups: low, normal weight (reference), overweight, obese, and severely obese.
We found 40 studies with 250,152 patients that had a mean follow-up of 3.8 years. Patients with a low body-mass index (BMI) (ie, <20) had an increased relative risk (RR) for total mortality (RR=1.37 [95% CI 1.32-1.43), and cardiovascular mortality (1.45 [1.16-1.81]), overweight (BMI 25-29.9) had the lowest risk for total mortality (0.87 [0.81-0.94]) and cardiovascular mortality (0.88 [0.75-1.02]) compared with those for people with a normal BMI. Obese patients (BMI 30-35) had no increased risk for total mortality (0.93 [0.85-1.03]) or cardiovascular mortality (0.97 [0.82-1.15]). Patients with severe obesity (> or =35) did not have increased total mortality (1.10 [0.87-1.41]) but they had the highest risk for cardiovascular mortality (1.88 [1.05-3.34]).
The better outcomes for cardiovascular and total mortality seen in the overweight and mildly obese groups could not be explained by adjustment for confounding factors. These findings could be explained by the lack of discriminatory power of BMI to differentiate between body fat and lean mass.
Available from: Kai-Ping Chang
- "To our knowledge, this is the largest study to date to analyze the prognostic significance of BMI in cancer patients with DM. Our current results are in accordance with previous data showing a favorable prognostic significance of overweight and obesity in different cohorts of patients with chronic diseases, including rheumatoid arthritis, cardiovascular disease, chronic obstructive pulmonary disease, and chronic renal failure [9, 10, 27]. "
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ABSTRACT: Recent studies conducted in patients with chronic diseases have reported an inverse association between body mass index (BMI) and mortality. However, the question as to whether BMI may predict prognosis in patients with metastatic cancer remains open. We therefore designed the current retrospective study to investigate the potential association between BMI and overall survival (OS) in patients with distant metastases (DM) and a favorable performance status. Between 2000 and 2012, a total of 4010 cancer patients with DM who required radiotherapy (RT) and had their BMI measured at the initiation of RT were identified. The relation between BMI and OS was examined by univariate and multivariable analysis. The median OS time was 3.23 months (range: 0.1–122.17) for underweight patients, 6.08 months (range: 0.03–149.46) for normal-weight patients, 7.99 months (range: 0.07–158.01) for overweight patients, and 12.49 months (range, 0.2–164.1) for obese patients (log-rank: P < 0.001). Compared with normal-weight patients, both obese (HR = 0.676; 95% P < 0.001) and overweight individuals (HR = 0.84; P < 0.001) had a reduced risk of all-cause mortality in multivariable analysis. Conversely, underweight patients had a significantly higher risk of death from all causes (HR = 1.41; P < 0.001). Overweight and obesity are independent predictors of better OS in metastatic patients with a good performance status. Increased BMI may play a role to identify metastatic patients with superior survival outcome and exhibit a potential to encourage aggressive management in those patients even with metastases.
Available from: David Haslam
- "However, once HF has occurred the opposite is true; a meta-analysis of 28,209 recruits  showed a reduction in CV mortality of 40% and all-cause mortality of 33%. In a review of trials including 250,000 individuals with coronary artery disease, cardiovascular and mortality outcomes were better in overweight and 'mildly' obese patients compared with 'normal' weight . The INVEST  study included 22,500 individuals with hypertension and coronary artery disease, and demonstrated a lower mortality and major CV events in the overweight and obese compared to those of normal weight. "
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ABSTRACT: Government and societal efforts to combat obesity are aimed at prevention, although there is a generation for whom excess weight is the rule rather than the exception. Although measures to prevent a worsening of the current epidemic are important, management of obesity must also be prioritised. Obesity management is beset with problems ranging from attitudinal to clinical and pharmacological, and the individualisation of therapy.
Available from: Peter Wohlfahrt
- "However, BMI has only 50% sensitivity to detect excess adiposity  and it is not able to differentiate between an elevated body fat content and preserved or increased lean mass, especially in individuals with a BMI < 30 kg/ m 2 . This may explain better cardiovascular outcomes seen in overweight and mildly obese  and increased risk of mortality in normal weight subjects with central obesity . Several studies have shown that measures assessing abdominal fat mass may be more closely related to cardiovascular morbidity and mortality than measures of general obesity [39e41]. "
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Increased aortic stiffness may be one of the mechanisms by which obesity increases cardiovascular risk independently of traditional risk factors. While body mass index (BMI) is generally used to define excess adiposity, several studies have suggested that measures of central obesity may be better predictors of cardiovascular risk. However, data comparing the association between several measures of central and general obesity with aortic stiffness in the general population are inconclusive.
In 1031 individuals (age 53 ± 13 years, 45% men) without manifest cardiovascular disease randomly selected from population, we tested the association between parameters of central obesity (waist circumference - WC, waist-to-hip-ratio - WHR, waist-to-height ratio - WHtR) and general obesity (BMI) with carotid-femoral pulse wave velocity (cfPWV).
In univariate analysis, WC and WHtR were more strongly associated with cfPWV than BMI in both genders, while WHR showed a stronger association with cfPWV only in women. WHtR was more closely associated with cfPVW than WHR. This difference between obesity measures remained after multivariate adjustment. When the fully adjusted hierarchical regression was used, among central obesity measures, WHtR had the largest additive value on top of BMI, while there was no additive value of BMI on top of WHtR.
Central obesity parameters are more closely associated with aortic stiffness than BMI. Of central adiposity measures, WHtR has the strongest association with aortic stiffness beyond body mass index and cardiovascular risk factors. Our results suggest that WHtR may be the best anthropometric measure of excess adiposity in the general population.
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