Body mass index and mortality in acutely decompensated heart failure across the world: a global obesity paradox. Is obesity a predictor of mortality, morbidity and readmission after cardiac surgery? The Influence of Body Mass Index on Outcomes in Patients Undergoing Cardiac Surgery: Does the Obesity Paradox Really Exist? Relationship of body mass index with outcomes after coronary artery bypass graft surgery. Influence of obesity on outcomes in atrial fibrillation: yet another obesity paradox. Obesity paradox in patients with hypertension and coronary artery disease. [Consequences of obesity in outcomes after cardiac surgery. Analysis of ARIAM registry]. The impact of body mass index on short- and long-term outcomes inpatients undergoing coronary revascularization. Insights from the bypass angioplasty revascularization investigation (BARI). Impact of body mass index on the outcome of patients with multivessel disease randomized to either coronary artery bypass grafting or stenting in the ARTS trial: The obesity paradox II? Cardiac procedures in patients with a body mass index exceeding 45: outcomes and long-term results. Cardiovascular risk in relation to body mass index and use of evidence-based preventive medications in patients with or at risk of atherothrombosis.
OBJECTIVES This study sought to define the relationship between  body mass index ( BMI )  and mortality in heart failure ( HF ) across the world and to identify specific groups in whom BMI may differentially mediate risk . BACKGROUND Obesity is associated with incident HF , but it is paradoxically associated with better prognosis during chronic HF . METHODS We studied 6,142 patients with acute decompensated HF from 12 prospect i ve observational cohorts followed-up across 4 continents . Primary outcome was all-cause mortality . Cox proportional hazards models and net reclassification index described associations of BMI with all-cause mortality . RESULTS Normal-weight patients ( BMI 18.5 to 25 kg/m(2 ) ) were older with more advanced HF and lower cardiometabolic risk . Despite worldwide heterogeneity in clinical features across obesity categories , a higher BMI remained associated with decreased 30-day and 1-year mortality ( 11 % decrease at 30 days ; 9 % decrease at 1 year per 5 kg/m(2 ) ; p < 0.05 ) , after adjustment for clinical risk . The BMI obtained at index admission provided effective 1-year risk reclassification beyond current markers of clinical risk ( net reclassification index 0.119 , p < 0.001 ) . Notably , the " protective " association of BMI with mortality was confined to persons with older age ( > 75 years ; hazard ratio [ HR ] : 0.82 ; p = 0.006 ) , decreased cardiac function ( ejection fraction < 50 % ; HR : 0.85 ; p < 0.001 ) , no diabetes ( HR : 0.86 ; p < 0.001 ) , and de novo HF ( HR : 0.89 ; p = 0.004 ) . CONCLUSIONS A lower BMI is associated with age , disease severity , and a higher risk of death in acute decompensated HF . The " obesity paradox " is confined to older persons , with decreased cardiac function , less cardiometabolic illness , and recent-onset HF , suggesting that aging , HF severity/chronicity , and metabolism may explain the obesity paradox INTRODUCTION Obesity has been described as a risk factor for the development of coronary artery disease , but it has not been determined whether obesity is associated with adverse outcomes after cardiac surgery . Therefore , we analyzed a large cohort of patients who had undergone cardiac surgery to determine whether obesity is a predictor of mortality , morbidity or early readmission to hospital . METHODS At the London Health Sciences Centre , an academic tertiary care centre , we prospect ively entered data from the cardiac surgical data base from July 1999 to April 2002 . We collected data on 1310 consecutive , unselected patients who underwent cardiac surgery during that time . We assessed the degree of obesity using the body mass index ( BMI ) , and we prospect ively documented the occurrence of 10 major complications after surgery . They included stroke , reoperation for bleeding , life-threatening cardiac arrest or arrhythmia , new renal failure requiring dialysis , septicemia , mediastinitis , sternal dehiscence , respiratory failure , postoperative myocardial infa rct ion and low cardiac output necessitating intra-aortic balloon pump use . Univariable and multivariable analyses were conducted to determine the factors associated with and predictive of postoperative death and major complications . RESULTS An increased BMI did not increase the risk of early postoperative death . Furthermore , increased BMI was not a predictor of a patient experiencing any of the major complications , except sternal dehiscence . An increased BMI was associated with a higher likelihood of readmission to hospital within 30 days of discharge . CONCLUSION Obesity was not associated with adverse outcomes after cardiac operations , aside from the increased risks of sternal dehiscence and early hospital readmission Purpose Obesity influences risk stratification in cardiac surgery in everyday practice . However , some studies have reported better outcomes in patients with a high body mass index ( BMI ): this is known as the obesity paradox . The aim of this study was to quantify the effect of diverse degrees of high BMI on clinical outcomes after cardiac surgery , and to assess the existence of an obesity paradox in our patients . Methods A total of 2,499 consecutive patients requiring all types of cardiac surgery with cardiopulmonary bypass between January 2004 and February 2009 were prospect ively studied at our institution . Patients were divided into four groups based on BMI : normal weight ( 18.5–24.9 kg∙m−2 ; n = 523 ; 21.4 % ) , overweight ( 25–29.9kg∙m−2 ; n = 1150 ; 47 % ) , obese ( ≥30–≤34.9kg∙m−2 ; n = 624 ; 25.5 % ) and morbidly obese ( ≥35kg∙m−2 ; n = 152 ; 6.2 % ) . Follow-up was performed in 2,379 patients during the first year . Results After adjusting for confounding factors , patients with higher BMI presented worse oxygenation and better nutritional status , reflected by lower PaO2/FiO2 at 24h and higher albumin levels 48h after admission respectively . Obese patients showed a higher risk for Perioperative Myocardial Infa rct ion ( OR : 1.768 ; 95 % CI : 1.035–3.022 ; p = 0.037 ) and septicaemia ( OR : 1.489 ; 95 % CI : 1.282–1.997 ; p = 0.005 ) . In-hospital mortality was 4.8 % ( n = 118 ) and 1-year mortality was 10.1 % ( n = 252 ) . No differences were found regarding in-hospital mortality between BMI groups . The overweight group showed better 1-year survival than normal weight patients ( 91.2 % vs. 87.6 % ; Log Rank : p = 0.029 . HR : 1.496 ; 95 % CI : 1.062–2.108 ; p = 0.021 ) . Conclusions In our population , obesity increases Perioperative Myocardial Infa rct ion and septicaemia after cardiac surgery , but does not influence in-hospital mortality . Although we found better 1-year survival in overweight patients , our results do not support any protective effect of obesity in patients undergoing cardiac surgery BACKGROUND A debate exists whether obesity is a risk factor for operative mortality after  coronary artery bypass graft surgery ( CABG ) . The contradictory findings in the literature may largely be attributable to the variety of method ological approaches used to model the association between body mass index ( BMI ) and post-CABG outcomes . This study aims to investigate this association , and to uncover possible explanations for the lack of consensus across prior studies . METHODS Data were prospect ively collected on 80,792 patients who underwent a CABG procedure during a 14-year period at the 45 Department of Veterans Affairs cardiac surgery programs .  Generalized additive models were used to estimate the relationship of BMI and outcomes after a CABG procedure . RESULTS We found that the relationship of BMI with post-CABG mortality and morbidity is U-shaped with the minimum risk located around a BMI of 30 kg/m2 , indicating that patients classified as overweight have the lowest risk , and those in the lower end of the obese range do not have seriously elevated risk . This U-shape relationship is significantly nonlinear and robust to adjustment for other risk factors . CONCLUSIONS This study demonstrates that BMI is an independent predictor of mortality and morbidity after CABG surgery . Previous studies that model BMI linearly or as categories can not accurately capture this U-shaped relationship and are unlikely to find a significant contribution by including BMI . Further research is needed to determine the mechanisms of risk for patients with low and high BMI and whether interventions to modify BMI may improve patient outcomes BACKGROUND Obese patients have favorable outcomes in congestive heart failure , hypertension , peripheral vascular disease , and coronary artery disease . Obesity also has been linked with increased incidence of atrial fibrillation , but its influence on outcomes in atrial fibrillation patients has not been investigated . The objective of this research is to investigate the effect of obesity on outcomes in atrial fibrillation . METHODS The Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) study was one of the largest multicenter trials of atrial fibrillation , with 4060 patients . Subjects were r and omized to rate versus rhythm-control strategy . We performed a post hoc analysis of the National Heart , Lung and Blood Institute limited access data set of atrial fibrillation patients who had body mass index ( BMI ) data available in the AFFIRM study . BMI data were not available on 1542 patients . Patients with BMI > or=18.5 were split into normal ( 18.5 - 25 ) , overweight ( 25 - 30 ) , and obese ( > 30 ) categories as per BMI ( kg/m(2 ) ) . Multivariate Cox proportional hazards regression was used on the eligible 2492 patients . End points were all-cause mortality and cardiovascular mortality . RESULTS Over three fourths of all patients in our cohort were overweight or obese . There were 304 deaths ( 103 among normal weight , 108 among overweight , and 93 among obese ) and 148 cardiovascular deaths ( 54 among normal weight , 41 among overweight , and 53 among obese ) over a mean period of 3 years of patient follow-up . On multivariate analysis , overweight ( hazard ratio [ HR ] 0.64 ; 95 % confidence interval [ CI ] , 0.48 - 0.84 ; P=.001 ) and obese ( HR 0.80 ; 95 % CI , 0.68 - 0.93 ; P=.005 ) categories were associated with lower all-cause mortality as compared with normal weight . Overweight ( HR 0.40 ; 95 % CI , 0.26 - 0.60 ; P < .001 ) and obese patients ( HR 0.77 ; 95 % CI , 0.62 - 0.95 ; P=.01 ) also had lower cardiovascular mortality as compared with the normal weight patients . CONCLUSIONS Although in prior studies , obesity has been associated with increased risk of atrial fibrillation , an obesity paradox exists for outcomes in atrial fibrillation . Obese patients with atrial fibrillation appear to have better long-term outcomes than nonobese patients PURPOSE An obesity paradox , a " paradoxical " decrease in morbidity and mortality with increasing body mass index ( BMI ) , has been shown in patients with heart failure and those undergoing percutaneous coronary intervention . However , whether this phenomenon exists in patients with hypertension and coronary artery disease is not known . METHODS A total of 22,576 hypertensive patients with coronary artery disease ( follow-up 61,835 patient years , mean age 66+/-9.8 years ) were r and omized to a verapamil-SR or atenolol strategy . Dose titration and additional drugs ( tr and olapril and /or hydrochlorothiazide ) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure targets . Patients were classified into 5 groups according to baseline BMI : less than 20 kg/m2 ( thin ) , 20 to 25 kg/m2 ( normal weight ) , 25 to 30 kg/m2 ( overweight ) , 30 to 35 kg/m2 ( class I obesity ) , and 35 kg/m2 or more ( class II-III obesity ) . The primary outcome was first occurrence of death , nonfatal myocardial infa rct ion , or nonfatal stroke . RESULTS With patients of normal weight ( BMI 20 to<25 kg/m2 ) as the reference group , the risk of primary outcome was lower in the overweight patients ( adjusted hazard ratio [ HR ] 0.77 , 95 % confidence interval [ CI ] , 0.70 - 0.86 , P<.001 ) , class I obese patients ( adjusted HR 0.68 , 95 % CI , 0.59 - 0.78 , P<.001 ) , and class II to III obese patients ( adjusted HR 0.76 , 95 % CI , 0.65 - 0.88 , P < .001 ) . Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months ( -17.5+/-21.9 mm Hg/-9.8+/-12.4 mm Hg vs -20.7+/-23.1 mm Hg /-10.6+/-12.5 mm Hg , P<.001 ) . CONCLUSION In a population with hypertension and coronary artery disease , overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight , which was driven primarily by a decreased risk of all-cause mortality . Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention BACKGROUND AND OBJETIVE Obesity is a disease that affects a large part of the population and has been associated with worse outcomes after cardiac surgery . The aim of our study is to evaluate the consequences of obesity related to postoperative complications , hospital length of stay and mortality . METHODS Observational , prospect i ve , multicenter study of patients included in ARIAM registry of adult cardiac surgery between March 2008 to March 2011 . We analyzed clinical variables , the surgical procedure , postoperative complications and mortality , comparing the group of patients with body mass index ( BMI ) greater or less than 30 kg/m(2 ) . RESULTS The study included 4,172 patients with a mean age of 64.03 ( SD 12.08 ) years , BMI 28.53 ( 4.7 ) and EuroSCORE 5.58 ( 2.91 ) . In 1,490 patients ( 35.7 % ) BMI was greater than 30 . There were no differences in the development of overall postoperative complications ( 33 % in obese and non-obese 35.8 % , P=.07 ) , although there were less appreciated reoperation rate or stroke ( P<.05 ) , as well as further development postoperative renal failure ( P=.009 ) . After adjusting for severity and length of cardio by pass time , obese patients had lower mortality without being statistically significant . OR 0.94 ( 0.79 - 1.04 ) . There were no differences in ICU length of stay , but obese patients had greater Ward length of stay 9.04 ( 10.43 ) vs. 8.18 ( 9.2 ) days , P=.01 . CONCLUSIONS Obese patients undergoing cardiac surgery have a mortality , rate of complications and length of stay similar to non-obese . Obese patients required less reoperations but developed more frequently postoperative renal failure OBJECTIVES We sought to investigate the impact of body mass index ( BMI ) on short- and long-term outcomes after initial revascularization with percutaneous transluminal coronary angioplasty ( PTCA ) or coronary artery bypass graft surgery ( CABG ) .  BACKGROUND Equivocal results exist on the impact of BMI on the risk of in-hospital complications after PTCA or CABG , and no long-term mortality data exist from a large series of revascularized patients . METHODS From the r and omized series and observational registry of the Bypass Angioplasty Revascularization Investigation ( BARI ) , 2,108 patients who had PTCA and 1,526 patients who had CABG were evaluated by taking their BMI at study entry . They were classified as follows : low ( < 20 kg/m(2 ) ) , normal ( 20 to 24.9 kg/m(2 ) ) , overweight ( 25 to 29.9 kg/m(2 ) ) , class I obese ( 30 to 34.9 kg/m(2 ) ) and class II/III obese ( greater-than-or-equal 35 kg/m(2 ) ) . In-hospital complications and short- and long-term mortalities were compared between levels of BMI within each mode of initial revascularization . RESULTS Among patients who had PTCA , each unit increase in BMI was associated with a 5.5 % lower adjusted risk of a major in-hospital event ( death , myocardial infa rct ion , stroke , coma ) ; among patients who had CABG , no difference in the in-hospital outcome was observed according to BMI . In contrast , BMI was not associated with five-year mortality in the PTCA group ; among the CABG group , adjusted relative risks of five-year cardiac mortality according to levels of BMI were 0.0 ( low ) , 1.0 ( normal ) , 2.02 ( overweight ) , 3.16 ( class I obese ) and 4.85 ( class II/III obese ) ( linear p < 0.001 ) . CONCLUSIONS Body mass index appears to have a differential impact on short- and long-term outcomes after coronary revascularization . These results underscore the need for further research to identify factors responsible for the apparent short-term protective effect of a higher BMI in patients undergoing PTCA and to study the impact of weight reduction on the long-term survival of obese patients undergoing CABG The effect of body mass index ( BMI ) on outcomes after coronary artery revascularization remains controversial . We studied 1,203 patients who had multivessel coronary artery disease and underwent stenting ( n = 599 ) or coronary artery bypass grafting ( CABG ; n = 604 ) in the Arterial Revascularization Therapies Study . Patients were assigned to 1 of 3 groups according to BMI : < 25 , 25 to 30 , and > 30 kg/m(2 ) . At 3-year follow-up , the incidence of death , cerebrovascular events , or myocardial infa rct ion was similar for these BMI categories regardless of the revascularization technique used . Rates of repeat revascularization procedures were significantly higher among patients who had been r and omized to stenting but were similar across BMI groups . For patients who had been r and omized to undergo CABG , there was a significant decrease in repeat revascularization procedures in obese patients ( p = 0.03 ) . Among patients who underwent stenting , BMI had no effect on the 3-year combined end point of rate of major adverse cardiac or cerebrovascular events . Among patients who underwent CABG , major adverse cardiac or cerebrovascular event rates were significantly lower for patients who were obese ( 11 % ) or overweight ( 16 % ) compared with patients who had a normal BMI ( 24 % ; p = 0.008 ) . Thus , in a large cohort of patients who had multivessel coronary artery disease and underwent surgical or percutaneous revascularization , BMI had no effect on 3-year outcome of those who underwent stenting . Conversely , among patients who underwent CABG , those who were overweight or obese had a significantly better outcome than did those who had a normal BMI with regard to survival without major adverse cardiac or cerebrovascular events , mainly due to lower rates of repeat revascularization procedures BACKGROUND Obesity has become a public health crisis . Although prior studies in obese patients undergoing cardiac surgical procedures have shown variable effects on outcomes , data are limited for extremely obese patients ( body mass index [ BMI ] > or = 45 ) . We undertook this study to evaluate outcomes in this cohort . METHODS A retrospective analysis was performed on 14,571 patients in our data base who underwent cardiac operations from 1992 to 2005 . Patient demographics , comorbidities , and outcomes were recorded . A univariate analysis between two groups : BMI 21 to 34.9 and BMI 45 or more was performed . Logistic regression models were used to identify independent risk factors for 30-day mortality . Long-term follow-up of the extreme obese group was achieved . RESULTS We identified 128 extreme obese patients , and 480 patients with a BMI of 21.0 to 34.9 were r and omly selected for comparison . Univariate analysis showed significant differences in age , gender , and multiple comorbidities , as well as in cardiopulmonary bypass and cross-clamp times , operative procedure , and transfusion requirements . Extreme obese patients had a higher incidence of infection , acute renal failure , and 30-day mortality . Logistic regression analysis showed BMI , preoperative renal insufficiency , and transfusion status to be independent risk factors for 30-day mortality . Follow-up data did not reveal significant functional improvements . Long-term survival was 33.6 % at 12 years . CONCLUSIONS Extreme obese patients undergoing cardiac surgical procedures have higher perioperative morbidity and mortality compared with a lower BMI group . BMI and preoperative renal insufficiency increase mortality in both groups , whereas transfusion does so only in the extreme obese . These patients can realize acceptable outcomes from cardiac procedures , but continue to suffer from the comorbidities of obesity AIM Explore the relation between body mass index ( BMI ) and cardiovascular disease , and the influence of optimal medical therapy ( OMT ) on this relationship . METHODS AND RESULTS Patients from the REACH cohort , an international , prospect i ve cohort of patients with or at high risk of atherosclerosis with documentation of potential confounders , including treatments and risk factors , were followed up to 4 years ( n = 54 285 ) . Patients were categorized according to baseline BMI ( ranging from underweight to Grade III obesity ) . Optimal medical therapy was defined as the use of the four cardioprotective medication classes ( statins , ACE inhibitors/angiotensin II receptor blockers , β-blockers , and antiplatelet agents ) . The main outcomes were all-cause mortality , cardiovascular ( CV ) mortality , and CV events . In primary and secondary prevention , a reverse J-shaped curve best described the relationship between BMI categories and the incidence of the various outcomes . In secondary prevention , the highest adjusted risks were observed for underweight patients ( 1.97 , P < 0.01 , and 1.29 , P = 0.03 , for CV mortality and CV events ) and the lowest HRs were observed , respectively , in Grade II and Grade III obese patients ( 0.73 , P < 0.01 and 0.80 , P < 0.01 ) . The proportion of patients on OMT increased with BMI from 10.1 to 36 % ( P < 0.001 ) . The apparent CV protection conferred by obesity persisted in patients receiving OMT . CONCLUSION An obesity paradox was observed in both primary and secondary CV prevention patients . The intensity of use of evidence -based preventive medications does not account for the paradoxical CV protection associated with obesity . At extremes of BMI , further interventions beyond OMT may be needed to reduce CV risk
In the present series , overweight and obese patients had similar or slightly lower in-hospital mortality rates after cardiac surgery compared with normal-weight individuals .
Conversely , postoperative complication rates increased with higher BMI levels .
Most studies included in the review showed that overweight and obese patients had at least the same mortality rate as normal-weight patients , or even a lower death risk .
Pooled- data of the meta- analysis provided evidence on the association between higher BMI levels and a lower all-cause in-hospital mortality rate after cardiac surgery
The relationship between higher body mass index ( BMI ) , decreased morbidity and mortality is known as the " obesity paradox " , and has been described in cohorts of patients with hypertension , diabetes , heart failure , coronary and peripheral artery diseases , non-cardiac surgery , and end-stage renal disease .
Here we investigated the relationship between BMI and short-term outcomes after adult cardiac surgery to explore the existence of an obesity paradoxical effect .
A secondary objective was to perform an up date d systematic review to further analyze the association between BMI and 30-day in-hospital mortality after cardiac surgery .