Prognostic impact of body weight and abdominal obesity in women and men with cardiovascular disease
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BACKGROUND: Increased body mass index (BMI) and abdominal adiposity increase the risk of cardiovascular disease (CVD) in persons free of these diseases, but their independent prognostic impact in persons with CVD has not been well defined. METHODS: BMI, waist-to-hip ratio (WHR), and waist circumference (WC) were measured in 6620 men and 2182 women with a mean age of 66 and stable CVD without congestive heart failure (CHF) participating in the Heart Outcomes Prevention Evaluation (HOPE) study. The main outcomes were CVD death, myocardial infarction, stroke, hospitalization for CHF, and all-cause mortality. RESULTS: During the 4.5-year follow-up, 658 had a CVD death, 1018 a myocardial infarction, 364 a stroke, 297 a CHF event, and 1034 died. When compared with the first tertile, the third tertile of BMI increased the adjusted relative risk (RR) of myocardial infarction by 20% (P < .02). Patients in the third tertile of WC had an increased adjusted RR of 23% for myocardial infarction (P < .01), 38% for heart failure (P < .03), and 17% for total mortality (P < .05). For WHR, there was an increased adjusted RR of 24% for CVD death (P < .03), 20% for myocardial infarction (P < .01), and 32% for total mortality (P < .001). CONCLUSIONS: Obesity, particularly abdominal adiposity, worsens the prognosis of patients with CVD; weight reduction program should be integrated in the active management of these patients.
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