Underweight, obesity predict worse outcomes during invasive coronary procedures
Click Here to Manage Email Alerts
Adults with severe obesity and underweight who underwent invasive coronary angiography procedures were more likely to die of any cause during follow-up compared with patients with normal weight, researchers reported.
Data from a large Finnish registry also demonstrated that adults with normal weight and overweight had the lowest risk for overall death, suggesting an “obesity paradox” may apply to patients undergoing an invasive coronary procedure.
“Among patients undergoing coronary angiography, underweight and significant obesity are related to increased mortality risk, therefore we need to pay attention when underweight or very obese patients will be examined using invasive angiography and interventions,” Jari A. Laukkanen, MD, PhD, FESC, professor and cardiologist at the Institute of Clinical Medicine, University of Eastern Finland, told Healio. “The results show a bimodal mortality pattern across the whole spectrum of BMI categories.”
Laukkanen and colleagues analyzed data from 42,636 patients participating in the prospective Finnish KARDIO registry, which included adults who underwent invasive diagnostic and interventional procedures. The mean age of participants was 65 years and 60.4% were men; mean BMI was 27.4 kg/m2. Researchers assessed data on demographics, prevalent diseases, risk factors, coronary angiographies and interventions. Researchers stratified participants by BMI based on WHO cutoffs and estimated HRs for all‐cause mortality based on BMI classification: Underweight (BMI < 18.5 kg/m2), pre-obesity (25-30 kg/m2), obesity class I (30-35 kg/m2), obesity class II (35-40 kg/m2), and obesity class III (> 40 kg/m2).
The findings were published in Catheterization and Cardiovascular Interventions.
During median follow‐up of 4.9 years, there were 4,688 all‐cause deaths.
Compared with participants with a BMI between 18.5 kg/m2 and 25 kg/m2, the age‐adjusted HR for all‐cause mortality was 1.9 for those with underweight (95% CI, 1.49-2.43), 0.96 for those with pre-obesity (95% CI, 0.92-1.01), 1.04 for those with obesity class I (95% CI, 0.99-1.09), 1.08 for those with obesity class II (95% CI, 0.96-1.2) and 1.45 for those with obesity class III (95% CI, 1.22-1.72). Associations persisted after adjustment for sex, family history of CAD and follow-up time.
“The focus of invasive interventions should be among patients who would benefit most,” Laukkanen told Healio. “Normal-weight patients may have less extensive and non‐diffuse forms of CAD, which is beneficial to treat invasively compared with more advanced disease (and very diffuse CAD). We should encourage patients with obesity to lose weight, and we should be very careful if we perform invasive interventions on very lean patients, as there are risks too.”
Laukkanen said more research is needed on the possible relationship between body composition or body fat distribution, as assessed by waist circumference and body fat percentage, and adiposity‐related outcomes.
“Although BMI is the most commonly used measure of obesity, it cannot distinguish between adipose and lean body mass tissue or central vs. peripheral adiposity,” Laukkanen said.
For more information:
Jari A. Laukkanen, MD, PhD, FESC, can be reached at jariantero.laukkanen@uef.fi; Twitter: @laukkanenjari.
Collapse
Read more about
Click Here to Manage Email Alerts