Obesity, health status, and 7-year mortality in percutaneous coronary intervention: In search of an explanation for the obesity paradox

J.O. Younge, N.L.M. Damen, R.T. van Domburg, S.S. Pedersen

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background
Obesity is a growing health problem and is associated with adverse outcomes in coronary artery disease (CAD). However, recent studies have shown better survival in cardiovascular patients with overweight or obesity, which has been referred to as the “obesity paradox”. As there is no clear understanding of the phenomenon, we examined the association between body mass index (BMI) and all-cause mortality in patients treated with percutaneous coronary intervention (PCI) at 7-year follow-up, and the potential role of health status in explaining the obesity paradox.
Methods
Consecutive PCI patients (72.5% men; mean age 62.0 ± 11.2 years, range [27–90] years) from the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry completed the 36-item short-form health survey (SF-36) to assess health status at baseline. Patients were classified into a normal weight, overweight or obesity group.
Results
The prevalence of normal weight was 34.7% (354/1019), overweight was seen in 45.9% (468/1019) of patients, and 19.3% (197/1019) was obese. After a median follow-up of 7.0 ± 1.7 years, 163 deaths (16.0%) from any cause were recorded. Cumulative hazard functions differed significantly for the obese and overweight group when compared to the normal weight group (log-rank X2 = 6.59, p < 0.05). In multivariable analysis, overweight, but not obesity, remained associated with a lower risk for all-cause mortality (HR = 0.60, 95%CI [0.42–0.86], p = 0.005). Additionally, after adding the 8 health status SF-36 domains to the multivariate model, the association between overweight and mortality remained unchanged.
Conclusion
In our study population overweight, but not obesity, was associated with a lower risk for 7-year mortality in PCI patients. Health status as measured with the SF-36 did not seem to play a role in explaining the obesity paradox.Keywords: Obesity, Obesity paradox, Health status, PCI, Mortality
Original languageEnglish
Pages (from-to)1154-1158
JournalInternational Journal of Cardiology
Volume167
Issue number4
DOIs
Publication statusPublished - 2013

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Weights and Measures
Health Surveys
Stents
Body Mass Index

Cite this

Younge, J.O. ; Damen, N.L.M. ; van Domburg, R.T. ; Pedersen, S.S. / Obesity, health status, and 7-year mortality in percutaneous coronary intervention : In search of an explanation for the obesity paradox. In: International Journal of Cardiology. 2013 ; Vol. 167, No. 4. pp. 1154-1158.
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title = "Obesity, health status, and 7-year mortality in percutaneous coronary intervention: In search of an explanation for the obesity paradox",
abstract = "BackgroundObesity is a growing health problem and is associated with adverse outcomes in coronary artery disease (CAD). However, recent studies have shown better survival in cardiovascular patients with overweight or obesity, which has been referred to as the “obesity paradox”. As there is no clear understanding of the phenomenon, we examined the association between body mass index (BMI) and all-cause mortality in patients treated with percutaneous coronary intervention (PCI) at 7-year follow-up, and the potential role of health status in explaining the obesity paradox.MethodsConsecutive PCI patients (72.5{\%} men; mean age 62.0 ± 11.2 years, range [27–90] years) from the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry completed the 36-item short-form health survey (SF-36) to assess health status at baseline. Patients were classified into a normal weight, overweight or obesity group.ResultsThe prevalence of normal weight was 34.7{\%} (354/1019), overweight was seen in 45.9{\%} (468/1019) of patients, and 19.3{\%} (197/1019) was obese. After a median follow-up of 7.0 ± 1.7 years, 163 deaths (16.0{\%}) from any cause were recorded. Cumulative hazard functions differed significantly for the obese and overweight group when compared to the normal weight group (log-rank X2 = 6.59, p < 0.05). In multivariable analysis, overweight, but not obesity, remained associated with a lower risk for all-cause mortality (HR = 0.60, 95{\%}CI [0.42–0.86], p = 0.005). Additionally, after adding the 8 health status SF-36 domains to the multivariate model, the association between overweight and mortality remained unchanged.ConclusionIn our study population overweight, but not obesity, was associated with a lower risk for 7-year mortality in PCI patients. Health status as measured with the SF-36 did not seem to play a role in explaining the obesity paradox.Keywords: Obesity, Obesity paradox, Health status, PCI, Mortality",
author = "J.O. Younge and N.L.M. Damen and {van Domburg}, R.T. and S.S. Pedersen",
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Obesity, health status, and 7-year mortality in percutaneous coronary intervention : In search of an explanation for the obesity paradox. / Younge, J.O.; Damen, N.L.M.; van Domburg, R.T.; Pedersen, S.S.

In: International Journal of Cardiology, Vol. 167, No. 4, 2013, p. 1154-1158.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Obesity, health status, and 7-year mortality in percutaneous coronary intervention

T2 - In search of an explanation for the obesity paradox

AU - Younge, J.O.

AU - Damen, N.L.M.

AU - van Domburg, R.T.

AU - Pedersen, S.S.

PY - 2013

Y1 - 2013

N2 - BackgroundObesity is a growing health problem and is associated with adverse outcomes in coronary artery disease (CAD). However, recent studies have shown better survival in cardiovascular patients with overweight or obesity, which has been referred to as the “obesity paradox”. As there is no clear understanding of the phenomenon, we examined the association between body mass index (BMI) and all-cause mortality in patients treated with percutaneous coronary intervention (PCI) at 7-year follow-up, and the potential role of health status in explaining the obesity paradox.MethodsConsecutive PCI patients (72.5% men; mean age 62.0 ± 11.2 years, range [27–90] years) from the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry completed the 36-item short-form health survey (SF-36) to assess health status at baseline. Patients were classified into a normal weight, overweight or obesity group.ResultsThe prevalence of normal weight was 34.7% (354/1019), overweight was seen in 45.9% (468/1019) of patients, and 19.3% (197/1019) was obese. After a median follow-up of 7.0 ± 1.7 years, 163 deaths (16.0%) from any cause were recorded. Cumulative hazard functions differed significantly for the obese and overweight group when compared to the normal weight group (log-rank X2 = 6.59, p < 0.05). In multivariable analysis, overweight, but not obesity, remained associated with a lower risk for all-cause mortality (HR = 0.60, 95%CI [0.42–0.86], p = 0.005). Additionally, after adding the 8 health status SF-36 domains to the multivariate model, the association between overweight and mortality remained unchanged.ConclusionIn our study population overweight, but not obesity, was associated with a lower risk for 7-year mortality in PCI patients. Health status as measured with the SF-36 did not seem to play a role in explaining the obesity paradox.Keywords: Obesity, Obesity paradox, Health status, PCI, Mortality

AB - BackgroundObesity is a growing health problem and is associated with adverse outcomes in coronary artery disease (CAD). However, recent studies have shown better survival in cardiovascular patients with overweight or obesity, which has been referred to as the “obesity paradox”. As there is no clear understanding of the phenomenon, we examined the association between body mass index (BMI) and all-cause mortality in patients treated with percutaneous coronary intervention (PCI) at 7-year follow-up, and the potential role of health status in explaining the obesity paradox.MethodsConsecutive PCI patients (72.5% men; mean age 62.0 ± 11.2 years, range [27–90] years) from the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry completed the 36-item short-form health survey (SF-36) to assess health status at baseline. Patients were classified into a normal weight, overweight or obesity group.ResultsThe prevalence of normal weight was 34.7% (354/1019), overweight was seen in 45.9% (468/1019) of patients, and 19.3% (197/1019) was obese. After a median follow-up of 7.0 ± 1.7 years, 163 deaths (16.0%) from any cause were recorded. Cumulative hazard functions differed significantly for the obese and overweight group when compared to the normal weight group (log-rank X2 = 6.59, p < 0.05). In multivariable analysis, overweight, but not obesity, remained associated with a lower risk for all-cause mortality (HR = 0.60, 95%CI [0.42–0.86], p = 0.005). Additionally, after adding the 8 health status SF-36 domains to the multivariate model, the association between overweight and mortality remained unchanged.ConclusionIn our study population overweight, but not obesity, was associated with a lower risk for 7-year mortality in PCI patients. Health status as measured with the SF-36 did not seem to play a role in explaining the obesity paradox.Keywords: Obesity, Obesity paradox, Health status, PCI, Mortality

U2 - 10.1016/j.ijcard.2012.03.105

DO - 10.1016/j.ijcard.2012.03.105

M3 - Article

VL - 167

SP - 1154

EP - 1158

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

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