TY - JOUR
T1 - Mean BMI, visit-to-visit BMI variability and BMI changes during follow-up in patients with acute myocardial infarction with systolic dysfunction and/or heart failure: insights from the High-Risk Myocardial Infarction Initiative
AU - For the High-Risk Myocardial Infarction Database Initiative
AU - Stienen, Susan
AU - Ferreira, João Pedro
AU - Girerd, Nicolas
AU - Duarte, K. vin
AU - Lamiral, Zohra
AU - McMurray, John J. V.
AU - Pitt, Bertram
AU - Dickstein, Kenneth
AU - Zannad, Faiez
AU - Rossignol, Patrick
PY - 2019/11
Y1 - 2019/11
N2 - Background: In patients with acute myocardial infarction (MI), BMI < 18.5 kg/m 2 and a decrease in BMI during follow-up have been associated with poor prognosis. For BMI ≥ 25 kg/m 2 , an “obesity paradox” has been suggested. Recently, high visit-to-visit BMI variability has also been associated with poor prognosis in patients with coronary artery disease. Aims: To simultaneously evaluate several BMI measurements and study their association with cardiovascular (CV) outcomes in a large cohort of patients with acute myocardial infarction (MI) and left ventricular (LV) systolic dysfunction, heart failure (HF) or both. Methods: The high-risk MI dataset is pooled from four trials: CAPRICORN, EPHESUS, OPTIMAAL and VALIANT. Mean BMI, change from baseline, and variability were assessed during follow-up. The primary outcome was CV death. Cox-proportional hazard models were performed to study the association between the various BMI parameters and outcomes (median follow-up = 1.8 years). Results: A total of 12,719 patients were included (72% male, mean age 65 ± 11 years). Mean, change and visit-to-visit variability in BMI had a non-linear association with CV death (P < 0.001). Mean BMI < 26 kg/m 2 (vs. ≥ 26–35 kg/m 2 ) and BMI decrease during follow-up were independently associated with CV death (adjusted HR 1.32, 95% CI 1.16–1.51, P < 0.001 and adjusted HR 1.57, 95% CI 1.40–1.76, P < 0.001, respectively). Low and high BMI variability (< 2% and > 4%) were associated with increased event-rates, but lost statistical significance in sensitivity analysis including patients with ≥ 5 measurements or excluding patients with HF hospitalization, suggesting that BMI variability may be particularly associated with HF hospitalizations. Conclusion: Mean BMI < 26 kg/m 2 and a BMI decrease during follow-up were independently associated with CV death in patients with MI and LV systolic dysfunction, HF or both. These associations likely reflect poorer patient status and causality cannot be inferred.
AB - Background: In patients with acute myocardial infarction (MI), BMI < 18.5 kg/m 2 and a decrease in BMI during follow-up have been associated with poor prognosis. For BMI ≥ 25 kg/m 2 , an “obesity paradox” has been suggested. Recently, high visit-to-visit BMI variability has also been associated with poor prognosis in patients with coronary artery disease. Aims: To simultaneously evaluate several BMI measurements and study their association with cardiovascular (CV) outcomes in a large cohort of patients with acute myocardial infarction (MI) and left ventricular (LV) systolic dysfunction, heart failure (HF) or both. Methods: The high-risk MI dataset is pooled from four trials: CAPRICORN, EPHESUS, OPTIMAAL and VALIANT. Mean BMI, change from baseline, and variability were assessed during follow-up. The primary outcome was CV death. Cox-proportional hazard models were performed to study the association between the various BMI parameters and outcomes (median follow-up = 1.8 years). Results: A total of 12,719 patients were included (72% male, mean age 65 ± 11 years). Mean, change and visit-to-visit variability in BMI had a non-linear association with CV death (P < 0.001). Mean BMI < 26 kg/m 2 (vs. ≥ 26–35 kg/m 2 ) and BMI decrease during follow-up were independently associated with CV death (adjusted HR 1.32, 95% CI 1.16–1.51, P < 0.001 and adjusted HR 1.57, 95% CI 1.40–1.76, P < 0.001, respectively). Low and high BMI variability (< 2% and > 4%) were associated with increased event-rates, but lost statistical significance in sensitivity analysis including patients with ≥ 5 measurements or excluding patients with HF hospitalization, suggesting that BMI variability may be particularly associated with HF hospitalizations. Conclusion: Mean BMI < 26 kg/m 2 and a BMI decrease during follow-up were independently associated with CV death in patients with MI and LV systolic dysfunction, HF or both. These associations likely reflect poorer patient status and causality cannot be inferred.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85064280326&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30953180
U2 - https://doi.org/10.1007/s00392-019-01453-7
DO - https://doi.org/10.1007/s00392-019-01453-7
M3 - Article
C2 - 30953180
SN - 1861-0684
VL - 108
SP - 1215
EP - 1225
JO - Clinical research in cardiology
JF - Clinical research in cardiology
IS - 11
ER -