In:
Cardiology, S. Karger AG
Abstract:
Introduction: This meta-analysis brings comprehensive evaluation about still controversial association between the body mass index (BMI) and the outcomes of acute coronary syndrome (ACS).
Methods: PubMed/ScienceDirect databases were systematically searched for studies with baseline parameters, primary (heart failure (HF), cardiogenic shock, cardiac arrest, reinfarction, stroke, death, total in-hospital complications) and secondary outcomes (reinfarction, stroke, death, total major adverse cardiovascular events (MACE)) in relation to BMI strictly classified into four groups (Underweight ( 〈 18.5 kg/m2), Normal weight (18.5-24.9 kg/m2), Overweight (25.0-29.9 kg/m2) and Obese (≥30.0 kg/m2), grouped into Mildly Obese (30.0-34.9 kg/m2) and Severely Obese (≥35.0 kg/m2)).
Results: We included 24 studies, with 585,919 participants (55.5% males), aged 66.8 years. Underweight was negatively associated with hypertension, hyperlipidemia and diabetes, and positively with primary outcomes (HF (Odds ratio (OR)=1.37, Confidence interval (CI) [1.15-1.63] ), cardiogenic shock (OR=1.43, CI [1.04-1.98]), stroke (OR=1.21, CI [1.05-1.40] ), overall death (OR=1.64, CI [1.20-2.26]), total in-hospital complications (OR=1.39, CI [1.24-1.56] )) and secondary outcomes during 34-month follow-up (cardiovascular/overall death (OR=3.78, CI [1.69-8.49]/OR=2.82, CI [2.29-3.49] ), respectively), total MACE (OR=2.77, CI [2.30-3.34])) (for all P 〈 0.05). Obesity had positive association with hypertension, hyperlipidemia, diabetes and smoking, and negative with primary outcomes (reinfarction (OR=0.83, CI [0.76-0.91]), stroke (OR=0.67, CI [0.54-0.85] ), overall death (OR=0.55, CI [0.49-0.63]), total in-hospital complications (OR=0.81, CI [0.70-0.93] )) and secondary outcomes (cardiovascular/overall death (OR=0.77, CI [0.66-0.88]/OR=0.62, CI [0.53-0.72] ), respectively), total MACE (OR=0.63, CI [0.60-0.77])) (for all P 〈 0.05). This negative association with several primary outcomes (cardiogenic shock, overall death, total in-hospital complications) and secondary outcomes (cardiovascular/overall death, total MACE) was more pronounced in mild obesity (P 〈 0.05). These results give an „obesity paradox” with a bimodal pattern (slightly U-shaped).
Conclusion: Obesity is positively associated with traditional cardiovascular risk factors and negatively with primary and secondary outcomes, which confirms the persistence of overall „obesity paradox“.
Type of Medium:
Online Resource
ISSN:
0008-6312
,
1421-9751
Language:
English
Publisher:
S. Karger AG
Publication Date:
2023
detail.hit.zdb_id:
1482041-9
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