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Central Obesity and Survival in Subjects With Coronary Artery Disease: A Systematic Review of the Literature and Collaborative Analysis With Individual Subject Data

T Coutinho, K Goel, D Correa de Sa... - Journal of the ..., 2011 - Am Coll Cardio Found Objectives: The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients. ... Background: The question of which ...

Thais Coutinho, MD*,, Kashish Goel, MD*,, Daniel Corr a de S , MD*, Charlotte Kragelund, MD, Ph D, Alka M. Kanaya, MD, Marianne Zeller, Ph D||, Jong-Seon Park, MD , Lars Kober, MD, Ph D, Christian Torp-Pedersen, MD, Ph D, Yves Cottin, MD, Ph D#, Luc Lorgis, MD#, Sang-Hee Lee, MD , Young-Jo Kim, MD , Randal Thomas, MD, M Sc*,, V ronique L. Roger, MD, MPH*,, Virend K. Somers, MD, Ph D*, and Francisco Lopez-Jimenez, MD, M Sc*,,*

* Department of Medicine, Mayo Clinic, Rochester, Minnesota Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota Department of Cardiology, Rigshospitalet, Copenhagen, Denmark Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, California

|| Laboratory of Experimental Cardiovascular Pathophysiology and Pharmacology, IFR sant -STIC, Faculty of Medicine, University of Burgundy, Dijon, France Department of Internal Medicine, Division of Cardiology, Yeungnam University Hospital, Daegu, Korea

# Service de Cardiologie, CHU Bocage, Dijon, France

Manuscript received September 2, 2010; revised manuscript received November 9, 2010, accepted November 18, 2010.

Objectives: The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients.

Methods: We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months.

Results: From 2,188 studies found, 6 met inclusion criteria. We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort. A variable called "central obesity" was created on the basis of tertiles of WHR or WC. Cox-proportional hazards were adjusted for age, sex, and confounders. The final sample consisted of 15,923 subjects. There were 5,696 deaths after a median follow-up of 2.3 (interquartile range 0.5 to 7.4) years. Central obesity was associated with mortality (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.58 to 1.83), whereas BMI was inversely associated with mortality (HR: 0.64, 95% CI: 0.59 to 0.69). Central obesity was also associated with higher mortality in the subset of subjects with normal BMI (HR: 1.70, 95% CI: 1.52 to 1.89) and BMI 30 kg/m2 (HR: 1.93, 95% CI: 1.61 to 2.32).

Key Words: central obesity coronary artery disease mortality waist circumference waist-hip ratio