Excess weight at time of presentation of myocardial infarction is associated with lower initial mortality risks but higher long-term risks including recurrent re-infarction and cardiac death.

Abstract

OBJECTIVES:

To evaluate the influence of elevated body mass index (BMI) on short- and long-term survival following acute myocardial infarction (AMI).

BACKGROUND:

Recent studies suggest an obesity survival paradox in individuals undergoing percutaneous coronary intervention with better 30-day and 1-year outcomes in obese relative to normal weight patients. We tested a similar obesity paradox hypothesis following acute myocardial infarction.

METHODS:

Short- and long-term all-cause mortality, and risk of recurrent AMI were evaluated according to BMI status in 894 consecutive survivors of AMI <80 years of age admitted to the Mayo Clinic Coronary Care Unit between January 1, 1988 and April 16, 2001. Normal weight, overweight and obesity were defined as BMI <25, 25-29.9, and >30 kg/m(2), respectively.

RESULTS:

Overall mortality following hospital discharge was significantly lower in overweight and obese patients and was mostly attributable to lower 6-month mortality (adjusted HR = 0.47, P = 0.01 for BMI >25 kg/m(2)) relative to normal weight patients, while long-term mortality among 6-month survivors was similar in all 3 groups. The risk of recurrent AMI was higher in patients with BMI >25 kg/m(2) (adjusted HR = 2.30, P = 0.01). Overweight and obese patients were significantly more likely to die from cardiac rather than non-cardiac causes (P < 0.01).

CONCLUSIONS:

Following AMI, overweight and obese individuals although paradoxically protected from short-term death have a long-term mortality risk that is similar to normal weight individuals. Younger age at the time of initial infarction and fewer non-cardiovascular comorbidities presumably explain the short-lived obesity survival paradox following myocardial infarction.

• Authors: Anil Nigam, R Scott Wright, Thomas G Allison, Brent A Williams, Stephen L Kopecky, Guy S Reeder, Joseph G Murphy, Allan S Jaffe
• Journal: International journal of cardiology (Int J Cardiol) Vol. 110 Issue 2 Pg. 153-9 (Jun 16 2006) ISSN: 0167-5273 [Print] Netherlands
• PMID: 16043245 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Body Mass Index
• Case-Control Studies
• Death
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Myocardial Infarction (mortality, prevention & control)
• Obesity (complications, mortality)
• Overweight
• Recurrence
• Retrospective Studies
• Risk Factors
• Survival Rate
• Time Factors