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Epidemiology and Population Health

Association of obesity indices with in-hospital and 1-year mortality following acute coronary syndrome

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Abstract

Background/objectives

According to the “obesity paradox”, adults with obesity have a survival advantage following acute coronary syndrome, compared with those without obesity. Previous studies focused on peripheral obesity and whether this advantage is conferred by central obesity is unknown. The objective of this study was to describe the association of peripheral and central obesity indices with risk of in-hospital and 1-year mortality following acute coronary syndrome (ACS).

Subjects/methods

Gulf COAST is a prospective ACS registry that enrolled 4044 patients age ≥18 years from January 2012 through January 2013, across 29 hospitals in four Middle Eastern countries. Associations of indices of peripheral obesity (body-mass index, [BMI]) and central obesity (waist circumference [WC] and waist-to-height ratio [WHtR]) with mortality following ACS were analyzed in logistic regression models (odds ratio, 95% CI) with and without adjustment for Global Registry of Acute Coronary Events risk score.

Results

Of 3882 patients analyzed (mean age: 60 years; 33.3% women [n = 1294]), the prevalence of obesity was 34.5% (BMI ≥ 30.0 kg/m2), 72.2% (WC ≥ 94.0 cm [men] or ≥80.0 cm [women]) and 90.0% (WHtR ≥ 0.5). In adjusted models, deciles of obesity indices showed higher risk of mortality at extreme versus intermediate deciles (U-shaped). When defined by conventional cut-offs, peripheral obesity (BMI ≥ 30.0 versus 18.5–29.9 kg/m2) showed inverse association with risk of in-hospital mortality (0.64; 95% CI, 0.42–0.99; P = 0.04; central obesity showed trend toward reduced mortality). In contrast, for risk of 1-year mortality, all indices showed inverse association. Obesity, defined by presence of all three indices, versus nonobesity showed inverse association with risk of 1-year mortality (0.52; 95% CI, 0.35–0.75; P = 0.001). Results were similar among men and women.

Conclusion

The degree of obesity paradox following ACS depends on the obesity index and follow-up time. Obesity indices may aid in risk stratification of mortality following ACS.

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Fig. 1: Association between deciles of obesity indices and all-cause in-hospital mortality (a–c) and 1-year mortality (d–f) following ACS, adjusted for GRACE risk score.
Fig. 2: Association between obesity indices using conventional cut-offs and all-cause in-hospital mortality (left) and 1-year mortality (right) following ACS, adjusted for GRACE risk score.
Fig. 3: Prevalence of overlapping obesity definitions.
Fig. 4: Association between overlapping obesity definitions and all-cause in-hospital mortality (left) and 1-year mortality (right) following ACS, adjusted for GRACE risk score.

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Funding

Gulf COAST is an investigator-initiated study that was supported by Astra Zeneca and Kuwait University (project code XX02/11). SM received support from the National Institutes of Health [R01 HL117861, R01 HL134811, K24 HL136852, R01 DK112940].

Author information

Author notes

  1. Zuhur Balayah

    Present address: Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

Authors and Affiliations

  1. College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates

    Zuhur Balayah & Alawi A. Alsheikh-Ali

  2. Division of Cardiology, Mubarak Al Kabeer Hospital, Kuwait University, Kuwait City, Kuwait

    Wafa Rashed

  3. Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

    Wael Almahmeed

  4. Department of Medicine, Cardiac Sciences Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates

    Arif Al Mulla

  5. Department of Medicine, Royal Hospital, Muscat, Oman

    Najib Alrawahi

  6. Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Samia Mora

  7. Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Samia Mora

  8. Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Sagar B. Dugani

  9. Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait

    Mohammad Zubaid

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  1. Zuhur Balayah
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Correspondence to Sagar B. Dugani.

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Conflict of interest

MZ, AAA-A, WA received speaking honoraria from Sanofi and Boehringer Ingleheim and Astra Zeneca. SM received research grant support from Atherotech Diagnostics and served as a consultant to Quest Diagnostics and Pfizer, for work unrelated to the current study.

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Balayah, Z., Alsheikh-Ali, A.A., Rashed, W. et al. Association of obesity indices with in-hospital and 1-year mortality following acute coronary syndrome. Int J Obes 45, 358–368 (2021). https://doi.org/10.1038/s41366-020-00679-0

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