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European Heart Journal Advance Access published online on August 17, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp317
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Obesity paradox in a cohort of 4880 consecutive patients undergoing percutaneous coronary intervention

Claire E. Hastie1, Sandosh Padmanabhan1, Rachel Slack2, Alastair C.H. Pell3, Keith G. Oldroyd4, Andrew D. Flapan5, Kevin P. Jennings6, John Irving7, Hany Eteiba4, Anna F. Dominiczak1 and Jill P. Pell2,*

1 British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, UK
2 Section of Public Health, University of Glasgow, Room 305, Public Health Section, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK
3 Monklands Hospital, Airdrie ML6 0JS, UK
4 West of Scotland Heart and Lung Centre, Glasgow G81 4HX, UK
5 Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
6 Aberdeen Royal Infirmary, Aberdeen AB25 2ZD, UK
7 Ninewells Hospital, Dundee DD1 9SY, UK

Received 7 January 2009; revised 22 May 2009; accepted 21 July 2009 * Corresponding author. Tel: +44 141 330 3239, Fax: +44 141 330 1874, Email: j.pell{at}clinmed.gla.ac.uk

Aims: We sought to investigate the impact of body mass index (BMI) on long-term all-cause mortality in patients following first-time elective percutaneous coronary intervention (PCI).

Methods and results: We used the Scottish Coronary Revascularisation Register to undertake a cohort study of all patients undergoing elective PCI in Scotland between April 1997 and March 2006 inclusive. We excluded patients who had previously undergone revascularization. There were 219 deaths within 5 years of 4880 procedures. Compared with normal weight individuals, those with a BMI ≥27.5 and <30 were at reduced risk of dying (HR 0.59, 95% CI 0.39–0.90, 95%, P = 0.014). There was no attenuation of the association after adjustment for potential confounders, including age, hypertension, diabetes, and left ventricular function (adjusted HR 0.59, 95% CI 0.39–0.90, P = 0.015), and there were no statistically significant interactions. The results were unaltered by restricting the analysis to events beyond 30 days of follow-up.

Conclusion: Among patients undergoing percutaneous intervention for coronary artery disease, increased BMI was associated with improved 5 year survival. Among those with established coronary disease, the adverse effects of excess adipose tissue may be offset by beneficial vasoactive properties.

Key Words: Angioplasty • Body mass index • Hypertension • Mortality • Obesity


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