Prognostic Impact of Body Weight and Abdominal Obesity in Women
Prognostic Impact of Body Weight and Abdominal Obesity in Women
Background: Increased body mass index (BMI) and abdominal adiposity increase the risk of cardiovascular disease (CVD) in persons free of these diseases, but their independent prognostic impact in persons with CVD has not been well defined.
Methods: BMI, waist-to-hip ratio (WHR), and waist circumference (WC) were measured in 6620 men and 2182 women with a mean age of 66 and stable CVD without congestive heart failure (CHF) participating in the Heart Outcomes Prevention Evaluation (HOPE) study. The main outcomes were CVD death, myocardial infarction, stroke, hospitalization for CHF, and all-cause mortality.
Results: During the 4.5-year follow-up, 658 had a CVD death, 1018 a myocardial infarction, 364 a stroke, 297 a CHF event, and 1034 died. When compared with the first tertile, the third tertile of BMI increased the adjusted relative risk (RR) of myocardial infarction by 20% ( P < .02). Patients in the third tertile of WC had an increased adjusted RR of 23% for myocardial infarction ( P < .01), 38% for heart failure ( P < .03), and 17% for total mortality ( P < .05). For WHR, there was an increased adjusted RR of 24% for CVD death ( P < .03), 20% for myocardial infarction ( P < .01), and 32% for total mortality ( P < .001).
Conclusions: Obesity, particularly abdominal adiposity, worsens the prognosis of patients with CVD; weight reduction program should be integrated in the active management of these patients.
Increasing obesity is a growing problem globally. Overweight (body mass index [BMI] = 25.0-29.9 kg/m) and particularly obesity (BMI = 30.0 kg/m and more) may be associated with hypertension, dyslipidemia, diabetes or insulin resistance, and elevated levels of fibrinogen and C-reactive protein, all of which increase the risk of cardiovascular disease (CVD) events. Several indexes have been used to determine whether weight excess per se is independently related to CVD. BMI has been shown to have variable relationships with CVD. In several, but not all observational studies, indexes of abdominal adiposity, such as waist-to-hip ratio (WHR) and waist circumference (WC), predict coronary heart disease and strokes better than BMI. These studies were primarily done in healthy persons, and the impact of total and abdominal adiposity has not been well defined in patients with stable CVD. The present report relates the impact of increased BMI, WHR, and WC on the occurrence of cardiovascular death, myocardial infarction, stroke, heart failure, and total mortality among 8802 men and women with CVD enrolled in the Heart Outcomes Prevention Evaluation (HOPE) study and observed during a median period of 4.5 years.
Background: Increased body mass index (BMI) and abdominal adiposity increase the risk of cardiovascular disease (CVD) in persons free of these diseases, but their independent prognostic impact in persons with CVD has not been well defined.
Methods: BMI, waist-to-hip ratio (WHR), and waist circumference (WC) were measured in 6620 men and 2182 women with a mean age of 66 and stable CVD without congestive heart failure (CHF) participating in the Heart Outcomes Prevention Evaluation (HOPE) study. The main outcomes were CVD death, myocardial infarction, stroke, hospitalization for CHF, and all-cause mortality.
Results: During the 4.5-year follow-up, 658 had a CVD death, 1018 a myocardial infarction, 364 a stroke, 297 a CHF event, and 1034 died. When compared with the first tertile, the third tertile of BMI increased the adjusted relative risk (RR) of myocardial infarction by 20% ( P < .02). Patients in the third tertile of WC had an increased adjusted RR of 23% for myocardial infarction ( P < .01), 38% for heart failure ( P < .03), and 17% for total mortality ( P < .05). For WHR, there was an increased adjusted RR of 24% for CVD death ( P < .03), 20% for myocardial infarction ( P < .01), and 32% for total mortality ( P < .001).
Conclusions: Obesity, particularly abdominal adiposity, worsens the prognosis of patients with CVD; weight reduction program should be integrated in the active management of these patients.
Increasing obesity is a growing problem globally. Overweight (body mass index [BMI] = 25.0-29.9 kg/m) and particularly obesity (BMI = 30.0 kg/m and more) may be associated with hypertension, dyslipidemia, diabetes or insulin resistance, and elevated levels of fibrinogen and C-reactive protein, all of which increase the risk of cardiovascular disease (CVD) events. Several indexes have been used to determine whether weight excess per se is independently related to CVD. BMI has been shown to have variable relationships with CVD. In several, but not all observational studies, indexes of abdominal adiposity, such as waist-to-hip ratio (WHR) and waist circumference (WC), predict coronary heart disease and strokes better than BMI. These studies were primarily done in healthy persons, and the impact of total and abdominal adiposity has not been well defined in patients with stable CVD. The present report relates the impact of increased BMI, WHR, and WC on the occurrence of cardiovascular death, myocardial infarction, stroke, heart failure, and total mortality among 8802 men and women with CVD enrolled in the Heart Outcomes Prevention Evaluation (HOPE) study and observed during a median period of 4.5 years.
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