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Cited by 94Diabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Disease and AdiposityCardiovascular Function and Risk Factors

Body Mass Index and Association With Cardiovascular Outcomes in Patients With Stable Coronary Heart Disease – A STABILITY Substudy

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Held, Claes, Hadziosmanovic, Nermin, Aylward, Philip E., Hagström, Emil, Hochman, Judith S., Stewart, Ralph A. H., White, Harvey D., Wallentin, Lars·2022·Journal of the American Heart Association
DOI 10.1161/jaha.121.023667PMC PMC9238503
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Abstract

BACKGROUND: The obesity paradox states that patients with higher body mass index (BMI) and cardiovascular disease may experience better prognosis. However, this is less clear in patients with coronary heart disease. METHODS AND RESULTS: The prospective STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial included 15 828 patients with stable coronary heart disease with 3 to 5 years’ follow‐up on optimal secondary preventive treatment. BMI was measured at baseline (n=15 785). Associations between BMI and cardiovascular outcomes were evaluated by Cox regression analyses with multivariable adjustments. Mean age was 64±9 years and 19% women. Most risk markers (diabetes, hypertension, inflammatory biomarkers, triglycerides) showed a graded association with higher BMI. The frequency of smoking, levels of high‐density lipoprotein, growth differentiation factor 15, and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) were higher at lower BMI. Low BMI (<20 kg/m 2 ; n=244 [1.5%]) was associated with doubled risk of total death (hazard ratio [HR], 2.27; 95% CI, 1.60–3.22), cardiovascular death (HR, 2.26; 95% CI, 1.46–3.49), and heart failure (HR, 2.51; 95% CI, 1.35–4.68) compared with BMI of 25 to <30 kg/m 2 (n=6752 [42.8%]) as reference. Similarly, high BMI of ≥35 kg/m 2 (n=1768 [11.2%]) was associated with increased risk of the same outcomes. A BMI between 20 and <25 kg/m 2 was associated with increased risk of cardiovascular death (HR, 1.26; 95% CI, 1.03–1.54) and total death (HR, 1.21; 95% CI, 1.03–1.42). CONCLUSIONS: Patients with stable coronary heart disease showed a graded increase in cardiometabolic and inflammatory risk factors with increasing BMI category >25 kg/m 2 . All‐cause and cardiovascular mortality were lowest at BMI of 25 to 35 kg/m 2 . Underweight with BMI of <20 kg/m 2 and very high BMI of ≥35 kg/m 2 were strong risk markers for poor prognosis. REGISTRATION: URL: https://clinicaltrials.gov/ ; Unique identifier NCT00799903.

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  • In patients with stable coronary heart disease, a BMI below 20 kg/m2 and a BMI of 35 kg/m2 or higher were significant indicators of a poor prognosis.

    “A BMI below 20 kg/m2 and a BMI of 35 kg/m2 or higher were significant indicators of a poor prognosis [29].”

    From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [29]

    The Abstract Conclusions describe both BMI <20 and ≥35 kg/m2 as strong markers of poor prognosis in patients with stable coronary heart disease. However, the Results (BMI and Association With Clinical Outcomes; page unavailable) report that, after multivariable adjustment, the elevated risks of cardiovascular death and heart-failure hospitalization at ≥35 kg/m2 were not statistically significant; increased total mortality was confined to the very-low-BMI group. Thus, calling both thresholds significant indicators overstates the findings. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • BMI serves as a useful tool to predict the risk and prognosis of certain chronic diseases.

    “Moreover, BMI serves as a useful tool to predict the risk and prognosis of certain chronic diseases.”

    From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [29]

    The Discussion (page not provided) reports that BMI was associated with cardiovascular death, total death, and heart-failure hospitalization in patients with stable coronary heart disease. This supports BMI as a prognostic marker in that population, but the paper does not establish its usefulness for predicting the risk and prognosis of chronic diseases more generally. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In patients with coronary heart disease, the lowest rates of all-cause and cardiovascular mortality were observed in the BMI range of 25 to 35 kg/m2.

    “Nevertheless, the lowest rates of all-cause and cardiovascular mortality among these patients with coronary heart disease were observed in the BMI range of 25 to 35 kg/m2, suggesting that BMI alone is too simplistic to give a comprehensive risk assessment in a clinical setting without consideration of many other factors.”

    From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [29]

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Authors
Held, C., Hadziosmanovic, N., Aylward, P. E., Hagström, E., Hochman, J. S., Stewart, R. A. H., White, H. D., & Wallentin, L.
Affiliations
  • Uppsala University (SE)
  • Flinders University (AU)
  • NYU Langone Health (US)
  • University of Auckland (NZ)
Corresponding author
Held, Claes
ORCID
Venue
Journal of the American Heart Association
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-02
Volume
11
Issue
3
Pages
e023667-e023667
ISSN
2047-9980 (ISSN-L)
DOI
10.1161/jaha.121.023667
PMC
PMC9238503
OpenAlex
W4205178117
Cited by
94
References
5
Citations by year
2026: 17 · 2025: 30 · 2024: 25 · 2023: 17 · 2022: 5
FWCI
14.27
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Journal of the American Heart Association (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords
body mass index, obesity paradox, stable coronary artery disease, cardiovascular mortality, all-cause mortality, heart failure, low body mass index, obesity, cardiometabolic risk factors, inflammatory markers, darapladib, secondary prevention, atherosclerotic plaque stabilization, NT-proBNP, growth differentiation factor 15, high-density lipoprotein, smoking, diabetes mellitus
MeSH terms
Aged, Coronary Disease, Female, Humans, Male, Middle Aged, Peptide Fragments, Prognosis, Prospective Studies, Risk Factors, Biomarkers, Body Mass Index, Natriuretic Peptide, Brain

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