European Heart Journal Advance Access originally published online on May 17, 2006
European Heart Journal 2006 27(12):1416-1422; doi:10.1093/eurheartj/ehl022
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Obesity and cardiovascular events in patients with established coronary disease
1 The Clinical Trials Group, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
2 George Washington University Biostatistics Center, Rockville, MD, USA
3 Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
4 Clinical Centers throughout the United States, Puerto Rico, Canada, and Italy (a full list can be found at, http://www.bsc.gwu.edu/peace/)
Received 28 June 2005; revised 1 March 2006; accepted 20 April 2006; online publish-ahead-of-print 17 May 2006.
* Corresponding authors. Tel: +1 301 435 0399; fax: +1 301 480 3667. E-mail address: domanskm{at}nhlbi.nih.gov (M.J.D.); Tel: +1 301 816 8039; fax: +1 301 881 3742. E-mail address: mrice{at}biostat.bsc.gwu.edu (M.M.R.)
See page 1390 for the editorial comment on this article (doi:10.1093/eurheartj/ehi869)
Aims To explore the association between obesity and major adverse coronary events (MACE) in patients with established coronary artery disease (CAD).
Methods and results The Prevention of Events with Angiotensin Converting Enzyme-Inhibition (PEACE) Trial randomized 8290 patients with stable CAD and left ventricular (LV) ejection fraction (EF) (LVEF) 
0.40 to trandolapril or placebo and followed them for a median of 4.8 years. In PEACE patients who were non-diabetic at baseline (5693 men and 1171 women), we used proportional hazards models to conduct a post hoc analysis to examine whether obesity, defined as a body mass index (BMI) 30 kg/m2, is an independent risk factor for the composite endpoint of MACE, defined as cardiovascular death, non-fatal myocardial infarction, coronary revascularization, or stroke. The analysis was conducted separately for men and women. The baseline prevalence of obesity was 28.5% in men and 28.9% in women. After adjusting for significant confounders, obesity was associated with MACE in men [hazard ratio (HR)=1.28, 95% CI 1.13–1.46, P<0.01], but not in women (HR=0.96, 95% CI 0.70–1.31, P=0.77). Further categorization of BMI showed a J-shaped association between BMI and MACE in the men, and no association in the women.
Conclusion In the presence of established CAD, obesity is associated with risk for MACE in men, but there is no support of an association in women. This finding requires further evaluation.
Key Words: Coronary artery disease • Obesity • Sex
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- Recurrent cardiovascular events in contemporary cardiology: obesity patients should not rest in PEACE
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