Association of Body Mass Index and Clinical Outcomes in Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Overview

Journal Acta Cardiol Sin

Date 2025 Jan 8

PMID 39776931

Authors

Ting-Yu Lin

Hsin-Bang Leu

Affiliations

Soon will be listed here.

Abstract

Background: The obesity paradox refers to lower mortality rates among overweight or obese individuals within certain populations. However, whether this paradox is applicable to patients undergoing percutaneous coronary intervention (PCI) remains unclear.

Methods: A total of 5,427 patients with coronary artery disease (CAD) who underwent successful PCI between 2005 and 2015 were enrolled. The association between body mass index (BMI) and future adverse cardiovascular events post PCI was analyzed. The study endpoints encompassed total cardiovascular (CV) events, including cardiac death, nonfatal myocardial infarction (MI), ischemic stroke, and hospitalization for congestive heart failure (CHF).

Results: Over an average follow-up period of 65.1 ± 32.1 months, 942 patients (17.4%) had CV events, including 200 CV deaths (3.7%), 294 acute MIs (5.4%), 111 ischemic strokes (2.0%), 469 CHF hospitalizations (8.6%), and 1,098 revascularizations (20.2%). A J-shaped relationship between BMI and future adverse events was observed, in which individuals with a BMI of 25.0-29.9 kg/m had significantly lower risks of total CV events [hazard ratio (HR) = 0.84, 95% confidence interval (CI) = 0.72-0.98], major adverse cardiovascular events (HR = 0.76, 95% CI = 0.63-0.93), acute MI (HR = 0.76, 95% CI = 0.58-1.00), and ischemic stroke (HR = 0.61, 95% CI = 0.39-0.95), compared to those with a BMI of 22.0-24.9 kg/m.

Conclusions: We found a J-shaped relationship between baseline BMI and future adverse events in CAD patients undergoing PCI. Overweight individuals (BMI 25.0-29.9 kg/m) had the lowest future risk of total CV events compared to those with a normal BMI (22.0-24.9 kg/m).

Citing Articles

Prevalence of macro-vascular complications among type 2 diabetic adults aged 50 and over: results from Ardakan cohort study on aging (ACSA).

Jenabi Ghods M, Amirabadizadeh A, Delbari A, Naserpour M, Saatchi M J Diabetes Metab Disord. 2025; 24(1):39.

PMID: 39801689 PMC: 11711917. DOI: 10.1007/s40200-024-01556-7.

References

Wallner S, Watzinger N, Lindschinger M, Smolle K, Toplak H, Eber B . Effects of intensified lifestyle modification on the need for further revascularization after coronary angioplasty. Eur J Clin Invest. 1999; 29(5):372-9. DOI: 10.1046/j.1365-2362.1999.00456.x. View

Bangalore S, Fayyad R, Laskey R, DeMicco D, Messerli F, Waters D . Body-Weight Fluctuations and Outcomes in Coronary Disease. N Engl J Med. 2017; 376(14):1332-1340. DOI: 10.1056/NEJMoa1606148. View

Stefan N, Haring H, Hu F, Schulze M . Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrinol. 2014; 1(2):152-62. DOI: 10.1016/S2213-8587(13)70062-7. View

Dwivedi A, Dubey P, Cistola D, Reddy S . Association Between Obesity and Cardiovascular Outcomes: Updated Evidence from Meta-analysis Studies. Curr Cardiol Rep. 2020; 22(4):25. DOI: 10.1007/s11886-020-1273-y. View

Iacobini C, Pugliese G, Blasetti Fantauzzi C, Federici M, Menini S . Metabolically healthy versus metabolically unhealthy obesity. Metabolism. 2018; 92:51-60. DOI: 10.1016/j.metabol.2018.11.009. View

Garanty-Bogacka B, Syrenicz M, Goral J, Krupa B, Syrenicz J, Walczak M . Changes in inflammatory biomarkers after successful lifestyle intervention in obese children. Endokrynol Pol. 2011; 62(6):499-505. View

Jensen M, Ryan D, Apovian C, Ard J, Comuzzie A, Donato K . 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2013; 63(25 Pt B):2985-3023. DOI: 10.1016/j.jacc.2013.11.004. View

Bhaskaran K, Dos-Santos-Silva I, Leon D, Douglas I, Smeeth L . Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3·6 million adults in the UK. Lancet Diabetes Endocrinol. 2018; 6(12):944-953. PMC: 6249991. DOI: 10.1016/S2213-8587(18)30288-2. View

Faggioni M, Baber U, Ehteshami Afshar A, Giustino G, Sartori S, Sorrentino S . Effects of Body Mass Index on Clinical Outcomes in Female Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents: Results From a Patient-Level Pooled Analysis of Randomized Controlled Trials. JACC Cardiovasc Interv. 2017; 11(1):68-76. DOI: 10.1016/j.jcin.2017.06.060. View

10.

Lissner L, Odell P, DAgostino R, Stokes 3rd J, Kreger B, Belanger A . Variability of body weight and health outcomes in the Framingham population. N Engl J Med. 1991; 324(26):1839-44. DOI: 10.1056/NEJM199106273242602. View

11.

Oreopoulos A, Padwal R, Norris C, Mullen J, Pretorius V, Kalantar-Zadeh K . Effect of obesity on short- and long-term mortality postcoronary revascularization: a meta-analysis. Obesity (Silver Spring). 2008; 16(2):442-50. DOI: 10.1038/oby.2007.36. View

12.

Chen S, Yang Y, Wu C, Huang S, Leong Chan W, Lin S . Association between Preoperative Nutritional Status and Clinical Outcomes of Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Nutrients. 2020; 12(5). PMC: 7282248. DOI: 10.3390/nu12051295. View

13.

Rosengren A . [Overweight, obesity...and BMI. The INTERHEART study shows that the BMI should probably be abolished--the waist-hip ratio is better]. Lakartidningen. 2006; 103(9):628. View

14.

Shamsuzzaman A, Gersh B, Somers V . Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA. 2003; 290(14):1906-14. DOI: 10.1001/jama.290.14.1906. View

15.

Lavie C, Pandey A, Lau D, Alpert M, Sanders P . Obesity and Atrial Fibrillation Prevalence, Pathogenesis, and Prognosis: Effects of Weight Loss and Exercise. J Am Coll Cardiol. 2017; 70(16):2022-2035. DOI: 10.1016/j.jacc.2017.09.002. View

16.

Lauretani F, Russo C, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A . Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol (1985). 2003; 95(5):1851-60. DOI: 10.1152/japplphysiol.00246.2003. View

17.

Hwang Y, Fujimoto W, Hayashi T, Kahn S, Leonetti D, Boyko E . Increased Visceral Adipose Tissue Is an Independent Predictor for Future Development of Atherogenic Dyslipidemia. J Clin Endocrinol Metab. 2015; 101(2):678-85. PMC: 4880131. DOI: 10.1210/jc.2015-3246. View

18.

Li Y, Lin G, Lin C, Wang J, Han C . Relation of body mass index to mortality among patients with percutaneous coronary intervention longer than 5 years follow-up: a meta-analysis. Int J Cardiol. 2013; 168(4):4315-8. DOI: 10.1016/j.ijcard.2013.04.174. View

19.

KRAUSS , Winston , Fletcher , Grundy . Obesity : impact on cardiovascular disease . Circulation. 1998; 98(14):1472-6. View

20.

Silveira E, Vaseghi G, de Carvalho Santos A, Kliemann N, Masoudkabir F, Noll M . Visceral Obesity and Its Shared Role in Cancer and Cardiovascular Disease: A Scoping Review of the Pathophysiology and Pharmacological Treatments. Int J Mol Sci. 2020; 21(23). PMC: 7730690. DOI: 10.3390/ijms21239042. View