Body Composition and Coronary Heart Disease Mortality-- An Obesity or a Lean Paradox?

September 2011
Mayo Clinic Proceedings;Sep2011, Vol. 86 Issue 9, p857
Academic Journal
OBJECTIVE: To determine the combined effects of body mass Index (BMI) and body fat (BF) on prognosis In coronary heart disease (CHD) to better understand the obesity paradox. PATIENTS AND METHODS: We studied 581. patients with CHD between January 1, 2000, and July 31, 2005, who were divided Into low (<25) and high BM1 (≥25), as well as iow (≥25% men and ≥35% women) and high BF (>25% in men and >35% in women). Four groups were analyzed by total mortailty during the 3-year follow-up by National Death Index: low BF/iow BMI (n=il9), high BF/low BMI (n26), low BF/hlgh BMI (n=125), and high BF/high BMI (n=311). RESULTS: During the 3-year follow-up, mortality was highest In the low BF/low BMI group (11%), which was significantly (P<.001) higher than that in the other 3 groups (3.9%, 3.2%, and 2.6%, re- spectIvely); using the high BF/high BM1 group as a reference, the low BF/low BMI group had a 4.24-fold increase in mortality (con- fidence interval [Cl], 1.76-10.23; P=.001). in multivariate logistic regression for mortality, when entered Individually, both high BMI (odds ratio [OR], 0.79; Cl, 0.69-0.90) and high BF (OR, 0.89; Cl, 0.82-0.95) as continuous variables were Independent predictors of better survival, whereas low BMI (OR, 3.60; Cl, and iow BF (OR, 3.52; Cl, 1.34-9.23) as categorical variables were independent predictors of higher mortality. CONCLUSION: Although both low BF and low BMI are independent predictors of mortality in patients with CHD, only patients with combined iow BF/low BMI appear to be at particularly high risk of mortality during follow-up. Studies are needed to determine optimal body composition in the secondary prevention of CHD.


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