Obesity Paradox Observed in PCI Outcomes

An elevated body mass index (BMI) may be a predictor of greater survival after PCI, according to research published July 3 in JACC: Cardiovascular Interventions.

Eric W. Holroyd, MD, and colleagues obtained data on 345,192 participants from the British Cardiovascular Intervention Society registry between 2005 and 2013. Based on BMI, patients were categorized as either lean, normal, overweight or obese. The percentage of obese patients undergoing PCI was 30 percent in 2005 and 32 percent in 2013. Obese patients were significantly younger, while lean patients were significantly older.

The odds of 30-day mortality were significantly lower in both overweight and obese patients, but did not reach statistical significance in the lean group. Similar observations were recorded at one year, with independent decreases in the odds of mortality in the overweight and obese groups and independent increases in odds of mortality in the lean group. Similar trends were recorded at three and five years. The odds for in-hospital bleeding complications were significantly less in obese patients following multivariate analysis compared with patients with normal BMIs and lean patients, which the authors attribute to higher rates of radial access in these patients. The researchers observed this obesity paradox with PCI in both stable coronary disease and in more acute clinical situations.

These findings support previous research for outcomes based on BMI after coronary revascularization. However, the authors write that the factors underlying this phenomenon remain uncertain and controversial and this study provides support for further exploration.

In an accompanying editorial comment, Debabrata Mukherjee, MD, FACC, and Chandra Ojha, MD, FACC, discuss the translation of these observations into meaningful advice for clinical practitioners and stress the importance of cardiorespiratory fitness for optimal cardiovascular outcomes.

“We should emphasize the importance of physical activity for everyone across all BMI levels, with 30 to 60 min of moderate-intensity aerobic activity, such as brisk walking, at least five days and preferably seven days per week,” they write. “Consistent with national guidelines, we also recommend that patients with established CVD undergo risk assessment with a physical activity history or an exercise test before starting an exercise program.” 

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Atherosclerotic Disease (CAD/PAD), Exercise

Keywords: Exercise Test, Body Mass Index, Walking, Research Personnel, Multivariate Analysis, Overweight, Obesity, Coronary Artery Disease, Exercise, Risk Assessment, Registries

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