Central Obesity and Survival in Subjects With Coronary Artery Disease: A Systematic Review of the Literature and Collaborative Analysis With Individual Subject Data

Study Questions:

Are central and total obesity associated with increased mortality among patients with coronary artery disease (CAD)?


A literature search using OVID/Medline, EMBASE, CENTRAL, and Web of Science was conducted in addition to a search for unpublished data from 1980 to 2008 with experts in the field. Inclusion criteria for all papers included subjects with CAD at baseline, measures of waist circumference, waist-to-hip circumference, data on mortality, and a minimum follow-up of 6 months. Central obesity was defined by tertiles of waist-to-hip ratio or waist circumference. The primary outcome of interest was mortality.


Of the 2,188 studies identified, six met inclusion criteria. All studies were published between 1980 and 2008. Data on individual subjects were obtained from four studies, and unpublished data from a cardiac rehabilitation cohort were also included. The final sample included 15,923 subjects. There were 5,696 deaths over a median follow-up of 2.3 years. The mean age of the cohort was 65.7 ± 11.5 years (59% were men). Central obesity was associated with increased mortality (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.58-1.83). Body mass index (BMI) was inversely associated with mortality (HR, 0.64; 95% CI, 0.59-0.69). Central obesity was associated with an increased risk of death in both those with a normal BMI (HR, 1.70; 95% CI, 1.52-1.89) and those with a BMI ≥30 (HR, 1.93; 95% CI, 1.61-2.32).


The investigators concluded that among adults with CAD, central obesity rather than BMI was associated with an increased risk of death.


Central obesity is a marker of visceral adiposity and increased risk of diabetes and CAD. These data suggest that central obesity is also associated with increased risk for death among patients with CAD. It is not clear as to whether reducing central obesity improves survival among this population.

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

Keywords: Obesity, Abdominal, Waist Circumference, Coronary Artery Disease, Waist-Hip Ratio, Follow-Up Studies, Body Mass Index, Adiposity, Diabetes Mellitus

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