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Higher Body Mass Index (BMI) is associated with decreased mortality in heart failure patients; a phenomenon termed the ‘Obesity Paradox’. This meta-analysis aims to evaluate BMI (kg/m2) as a predictor of 1-year mortality in patients with acute coronary syndromes (ACS).
We searched MEDLINE using the keywords myocardial infarction, ACS, BMI and mortality. For quantitative analysis we calculated the relative risk (RR) of all-cause mortality with 95% confidence intervals (CI) and P-values. Predictors of mortality were determined using weighted meta-regression. Both fixed-effects, and Der Simonian and Laird random-effects models were used to calculate the pooled RR across BMI categories.
14/674 studies met our eligibility criteria producing a cohort of 62,109 patients with ACS. The pooled RR of 1-year mortality was 0.76 (0.73–0.83) for those with a BMI ≥30 compared to <30 (Figure 1). Stratified analysis found that a BMI <18 had a RR of 0.42 (0.18–0.98) compared to a BMI of 18–24.9. A BMI of 25–29 had a RR of 0.62 (0.30–1.26) compared to a BMI of 18.5[[Unable to Display Character: –]]24.9 and a BMI ≥30 had a RR of 0.83 (0.46–1.51) compared to a BMI of 25–29. Using meta-regression, ejection fraction was the only predictor of mortality, being significantly lower in a BMI of 25–29 versus a BMI ≥30 (44% vs 49%, p<0.01). Diabetes and age were not seen as predictors (p<0.05).
This study demonstrates that the obesity paradox does exist in ACS, which could be partially explained by the effects of a higher ejection fraction.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Body Size and MI Risk: Is Bigger Better?
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1128M-200
- 2013 American College of Cardiology Foundation