Author + information
- Received September 2, 2010
- Revision received November 9, 2010
- Accepted November 18, 2010
- Published online May 10, 2011.
- Thais Coutinho, MD⁎,†,
- Kashish Goel, MD⁎,†,
- Daniel Corrêa de Sá, MD⁎,
- Charlotte Kragelund, MD, PhD‡,
- Alka M. Kanaya, MD§,
- Marianne Zeller, PhD∥,
- Jong-Seon Park, MD¶,
- Lars Kober, MD, PhD‡,
- Christian Torp-Pedersen, MD, PhD‡,
- Yves Cottin, MD, PhD#,
- Luc Lorgis, MD#,
- Sang-Hee Lee, MD¶,
- Young-Jo Kim, MD¶,
- Randal Thomas, MD, MSc⁎,†,
- Véronique L. Roger, MD, MPH⁎,†,
- Virend K. Somers, MD, PhD⁎,† and
- Francisco Lopez-Jimenez, MD, MSc⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Francisco Lopez-Jimenez, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905
Objectives The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients.
Background The question of which measure of obesity better predicts survival in patients with CAD is controversial.
Methods We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months.
Results From 2,188 studies found, 6 met inclusion criteria. We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort. A variable called “central obesity” was created on the basis of tertiles of WHR or WC. Cox-proportional hazards were adjusted for age, sex, and confounders. The final sample consisted of 15,923 subjects. There were 5,696 deaths after a median follow-up of 2.3 (interquartile range 0.5 to 7.4) years. Central obesity was associated with mortality (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.58 to 1.83), whereas BMI was inversely associated with mortality (HR: 0.64, 95% CI: 0.59 to 0.69). Central obesity was also associated with higher mortality in the subset of subjects with normal BMI (HR: 1.70, 95% CI: 1.52 to 1.89) and BMI ≥30 kg/m2 (HR: 1.93, 95% CI: 1.61 to 2.32).
Conclusions In subjects with CAD, including those with normal and high BMI, central obesity but not BMI is directly associated with mortality.
Dr. Torp-Pedersen is on the steering committee of SCOUT (sponsored by Abbott), has given paid lectures with Abbott, served on the advisory board for Neurosearch, and has received lecture honoraria and advisory honoraria from Abbott and Neurosearch. Dr. Thomas reports receiving a research grant from the Marriott Family Program in Individualized Medicine and community health awards from Stratis Health and Blue Cross-Blue Shield of Minnesota. Dr. Somers reports receiving research grants from Select Research, Phillips Respironics Foundation, ResMed, and Sorin, Inc., and is a consultant for ResMed, Cardiac Concepts, Johnson & Johnson, Apnex Medical, Sova, and Merck. All other authors have reported that they have no relationships to disclose.
- Received September 2, 2010.
- Revision received November 9, 2010.
- Accepted November 18, 2010.
- American College of Cardiology Foundation