European Heart Journal Advance Access originally published online on February 20, 2009
European Heart Journal 2009 30(7):857-865; doi:10.1093/eurheartj/ehp037
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The influence of body mass index on mortality and bleeding among patients with or at high-risk of atherothrombotic disease
1 Gleneagles Medical Centre, 6 Napier Road, No. 08-13, Singapore 258499, Singapore
2 VA Boston Healthcare System and Brigham and Women's Hospital, Boston, MA, USA
3 Cleveland Clinic, Cleveland, OH, USA
4 University of Texas Health Science Center, San Antonio, TX, USA
5 Kerckhoff Heart Center, Bad Nauheim, Germany
6 Royal Perth Hospital and School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
7 University of California San Francisco, San Francisco, CA, USA
8 Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France
9 Hôpital Bichat-Claude Bernard, Paris, France
10 The Geisinger Clinic, Danville, PA, USA and The Medicines Company, Zurich, Switerland
11 University and Royal Infirmary of Edinburgh, Edinburgh, UK
12 Scripps Translational Research Institute, La Jolla, CA, USA
Received 14 June 2008; revised 16 December 2008; accepted 17 December 2008; online publish-ahead-of-print 20 February 2009.
* Corresponding author. Tel: +65 6476 0880, Fax: +65 6475 0880, Email: makheart{at}gmail.com
See page 752 for the editorial comment on this article (doi:10.1093/eurheartj/ehp081)
Aims: We aimed to determine the relationship between body mass index (BMI) and cardiovascular events among individuals with or at-risk of atherothrombotic disease.
Methods and results: This was a prospective observational study of 15 532 patients enrolled in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial who were randomly assigned to clopidogrel or placebo, and followed-up for a median of 28 months for the occurrence of the primary endpoint (cardiovascular death, myocardial infarction, or stroke), all-cause mortality, and bleeding complications. Compared with the highest BMI quartile, the primary endpoint, cardiovascular, and all-cause mortality all occurred more frequently among patients in the lowest BMI quartile (about a third lower). The relationship between continuous BMI and adverse cardiovascular outcomes were presented as two linear spline terms with 29 kg/m2 as the cut-point for all-cause mortality. Lower BMI was associated with an increase in moderate and severe bleeding complications, largely accounted for by those receiving dual-antiplatelet agents with the highest tertile aspirin dose.
Conclusion: Adverse cardiovascular events and bleeding complications occurred more frequently among individuals with or at-risk for atherothrombotic disease and low BMI. Further studies should be directed to these patients to improve outcomes.
The CHARISMA trial is registered with ClinicalTrials.gov, NCT00050817 [ClinicalTrials.gov] .
Key Words: Aspirin • Cardiovascular • Clopidogrel • Myocardial infarction • Obesity • Stroke
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