Central Obesity and Survival in Subjects With Coronary Artery Disease: A Systematic Review of the Literature and Collaborative Analysis With Individual Subject Data

• Published in: Journal of the American College of Cardiology Vol. 57; no. 19; pp. 1877 - 1886
• Main Authors: COUTINHO, Thais, GOEL, Kashish, LORGIS, Luc, LEE, Sang-Hee, KIM, Young-Jo, THOMAS, Randal, ROGER, Veronique L, SOMERS, Virend K, LOPEZ-JIMENEZ, Francisco, CORREA DE SA, Daniel, KRAGELUND, Charlotte, KANAYA, Alka M, ZELLER, Marianne, PARK, Jong-Seon, KOBER, Lars, TORP-PEDERSEN, Christian, COTTIN, Yves
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 10.05.2011; Elsevier Limited
• Subjects: Age; Analysis; Animals; Biological and medical sciences; Body mass; Body Mass Index; Cardiac rehabilitation; Cardiology; Cardiology. Vascular system; Circulatory system; Cohort Studies; Cooperative Behavior; Coronary Artery Disease - complications; Coronary Artery Disease - mortality; Coronary heart disease; Coronary vessels; Death; Diseases; Follow-Up Studies; Heart; Heart attacks; Humans; Literature reviews; Medical sciences; Metabolic diseases; Mortality; Obesity; Obesity, Abdominal - complications; Obesity, Abdominal - mortality; Patients; Reviews; survival; Survival Rate - trends; Human; Obesity; Prognosis; Nutrition disorder; Cardiovascular disease; Data; Review; Coronary heart disease; Survival; Analysis; Cooperation; Individual; Circulatory system; Cardiology; Nutritional status; Bibliographic review
• DOI: 10.1016/j.jacc.2010.11.058
• ISSN: 0735-1097; 1558-3597

The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients. The question of which measure of obesity better predicts survival in patients with CAD is controversial. We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months. From 2,188 studies found, 6 met inclusion criteria. We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort. A variable called "central obesity" was created on the basis of tertiles of WHR or WC. Cox-proportional hazards were adjusted for age, sex, and confounders. The final sample consisted of 15,923 subjects. There were 5,696 deaths after a median follow-up of 2.3 (interquartile range 0.5 to 7.4) years. Central obesity was associated with mortality (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.58 to 1.83), whereas BMI was inversely associated with mortality (HR: 0.64, 95% CI: 0.59 to 0.69). Central obesity was also associated with higher mortality in the subset of subjects with normal BMI (HR: 1.70, 95% CI: 1.52 to 1.89) and BMI ≥30 kg/m(2) (HR: 1.93, 95% CI: 1.61 to 2.32). In subjects with CAD, including those with normal and high BMI, central obesity but not BMI is directly associated with mortality.