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dc.contributor.authorEisenstein, Eric Len
dc.contributor.authorMcGuire, Darren Ken
dc.contributor.authorBhapkar, Manjushri Ven
dc.contributor.authorKristinsson, Arnien
dc.contributor.authorHochman, Judith Sen
dc.contributor.authorKong, David Fen
dc.contributor.authorCaliff, Robert Men
dc.contributor.authorVan de Werf, Fransen
dc.contributor.authorYancy, William Sen
dc.contributor.authorNewby, L Kristinen
dc.date.accessioned2010-09-01T11:29:47Z
dc.date.available2010-09-01T11:29:47Z
dc.date.issued2005-09-01
dc.date.submitted2010-09-01
dc.identifier.citationAm. J. Med. 2005, 118(9):981-90en
dc.identifier.issn0002-9343
dc.identifier.pmid16164884
dc.identifier.doi10.1016/j.amjmed.2005.02.017
dc.identifier.urihttp://hdl.handle.net/2336/110578
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractPURPOSE: Obesity is a coronary disease risk factor, but its independent effect on clinical outcomes following acute coronary syndromes has not been quantified. We evaluated the relationship between elevated body mass index (BMI) and 30-day, 90-day, and 1-year clinical outcomes postacute coronary syndromes. SUBJECTS AND METHODS: Using 15 071 patients (normal weight [BMI = 18.5-24.9 kg/m(2)], overweight [BMI = 25-29.9 kg/m(2)], obese [BMI = 30-34.9 kg/m(2)] or very obese [BMI > or =35 kg/m(2)]) randomized from 1997-1999 in the SYMPHONY (Sibrafiban vs aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes) and 2nd SYMPHONY trials, we evaluated the relationships between BMI and 30-day, 90-day, and 1-year mortality and 30-day and 90-day death or myocardial infarction. RESULTS: Increasing BMI was associated with younger age, multiple comorbidities, and greater cardiac medication and procedure use; however, systolic function and coronary disease extent were similar for all BMI categories. Unadjusted Kaplan-Meier mortality estimates were higher for normal-weight patients than for all other BMI groups. After multivariable adjustment, the 30-day mortality hazard ratios (95% confidence interval [CI]) were: overweight, 0.66 (95% CI: 0.47 to 0.94); obese, 0.61 (95% CI: 0.39 to 0.97); very obese, 0.89 (95% CI: 0.48 to 1.64). Adjusted hazard ratios were similar for 90-day and 1-year mortality. There were no statistically significant differences among BMI groups in 30-day and 90-day death or myocardial infarction (unadjusted or adjusted). CONCLUSION: Overweight and obese BMI classifications were associated with better intermediate-term survival after acute coronary syndromes than normal weight and very obese, but death or myocardial infarction rates were similar. Further study is required to understand the apparent association of overweight and moderate obesity with better intermediate-term outcomes.
dc.language.isoenen
dc.publisherExcerpta Medicaen
dc.relation.urlhttp://dx.doi.org/10.1016/j.amjmed.2005.02.017en
dc.subject.meshAcute Diseaseen
dc.subject.meshAgeden
dc.subject.meshAngina, Unstableen
dc.subject.meshBody Mass Indexen
dc.subject.meshDisease-Free Survivalen
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshMyocardial Infarctionen
dc.subject.meshObesityen
dc.subject.meshRetrospective Studiesen
dc.subject.meshRisk Factorsen
dc.subject.meshSurvival Rateen
dc.subject.meshSyndromeen
dc.subject.meshTime Factorsen
dc.subject.meshTreatment Outcomeen
dc.titleElevated body mass index and intermediate-term clinical outcomes after acute coronary syndromesen
dc.typeArticleen
dc.contributor.departmentDuke University Medical Center and the Duke Clinical Research Institute, Durham, NC 27715, USA. eisen006@mc.duke.eduen
dc.identifier.journalAmerican journal of medicineen
html.description.abstractPURPOSE: Obesity is a coronary disease risk factor, but its independent effect on clinical outcomes following acute coronary syndromes has not been quantified. We evaluated the relationship between elevated body mass index (BMI) and 30-day, 90-day, and 1-year clinical outcomes postacute coronary syndromes. SUBJECTS AND METHODS: Using 15 071 patients (normal weight [BMI = 18.5-24.9 kg/m(2)], overweight [BMI = 25-29.9 kg/m(2)], obese [BMI = 30-34.9 kg/m(2)] or very obese [BMI > or =35 kg/m(2)]) randomized from 1997-1999 in the SYMPHONY (Sibrafiban vs aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes) and 2nd SYMPHONY trials, we evaluated the relationships between BMI and 30-day, 90-day, and 1-year mortality and 30-day and 90-day death or myocardial infarction. RESULTS: Increasing BMI was associated with younger age, multiple comorbidities, and greater cardiac medication and procedure use; however, systolic function and coronary disease extent were similar for all BMI categories. Unadjusted Kaplan-Meier mortality estimates were higher for normal-weight patients than for all other BMI groups. After multivariable adjustment, the 30-day mortality hazard ratios (95% confidence interval [CI]) were: overweight, 0.66 (95% CI: 0.47 to 0.94); obese, 0.61 (95% CI: 0.39 to 0.97); very obese, 0.89 (95% CI: 0.48 to 1.64). Adjusted hazard ratios were similar for 90-day and 1-year mortality. There were no statistically significant differences among BMI groups in 30-day and 90-day death or myocardial infarction (unadjusted or adjusted). CONCLUSION: Overweight and obese BMI classifications were associated with better intermediate-term survival after acute coronary syndromes than normal weight and very obese, but death or myocardial infarction rates were similar. Further study is required to understand the apparent association of overweight and moderate obesity with better intermediate-term outcomes.


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