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Mean BMI, visit-to-visit BMI variability and BMI changes during follow-up in patients with acute myocardial infarction with systolic dysfunction and/or heart failure: insights from the High-Risk Myocardial Infarction Initiative

  • Susan Stienen
  • João Pedro Ferreira
  • Nicolas Girerd
  • Kévin Duarte
  • Zohra Lamiral
  • John J. V. McMurray
  • Bertram Pitt
  • Kenneth Dickstein
  • Faiez Zannad
  • Patrick RossignolEmail author
  • For the High-Risk Myocardial Infarction Database Initiative
Original Paper
  • 145 Downloads

Abstract

Background

In patients with acute myocardial infarction (MI), BMI < 18.5 kg/m2 and a decrease in BMI during follow-up have been associated with poor prognosis. For BMI ≥ 25 kg/m2, an “obesity paradox” has been suggested. Recently, high visit-to-visit BMI variability has also been associated with poor prognosis in patients with coronary artery disease.

Aims

To simultaneously evaluate several BMI measurements and study their association with cardiovascular (CV) outcomes in a large cohort of patients with acute myocardial infarction (MI) and left ventricular (LV) systolic dysfunction, heart failure (HF) or both.

Methods

The high-risk MI dataset is pooled from four trials: CAPRICORN, EPHESUS, OPTIMAAL and VALIANT. Mean BMI, change from baseline, and variability were assessed during follow-up. The primary outcome was CV death. Cox-proportional hazard models were performed to study the association between the various BMI parameters and outcomes (median follow-up = 1.8 years).

Results

A total of 12,719 patients were included (72% male, mean age 65 ± 11 years). Mean, change and visit-to-visit variability in BMI had a non-linear association with CV death (P < 0.001). Mean BMI < 26 kg/m2 (vs. ≥ 26–35 kg/m2) and BMI decrease during follow-up were independently associated with CV death (adjusted HR 1.32, 95% CI 1.16–1.51, P < 0.001 and adjusted HR 1.57, 95% CI 1.40–1.76, P < 0.001, respectively). Low and high BMI variability (< 2% and > 4%) were associated with increased event-rates, but lost statistical significance in sensitivity analysis including patients with ≥ 5 measurements or excluding patients with HF hospitalization, suggesting that BMI variability may be particularly associated with HF hospitalizations.

Conclusion

Mean BMI < 26 kg/m2 and a BMI decrease during follow-up were independently associated with CV death in patients with MI and LV systolic dysfunction, HF or both. These associations likely reflect poorer patient status and causality cannot be inferred.

Keywords

Acute myocardial infarction Systolic dysfunction Body mass index Prognosis Variability 

Notes

Acknowledgements

The authors thank Pierre Pothier for editing the manuscript. SS, JF, NG, PR were supported by a Contrat de Plan Etat Lorraine, FEDER, and a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d’Avenir” program (reference: ANR-15-RHU-0004), and GEENAGE Impact Lorraine Université d’Excellence—reference ANR-15-IDEX-04-LUE.

Supplementary material

392_2019_1453_MOESM1_ESM.docx (623 kb)
Supplementary material 1 (DOCX 623 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Susan Stienen
    • 1
  • João Pedro Ferreira
    • 1
    • 2
  • Nicolas Girerd
    • 1
  • Kévin Duarte
    • 3
    • 4
    • 5
  • Zohra Lamiral
    • 1
  • John J. V. McMurray
    • 6
  • Bertram Pitt
    • 7
  • Kenneth Dickstein
    • 8
  • Faiez Zannad
    • 1
  • Patrick Rossignol
    • 1
    Email author
  • For the High-Risk Myocardial Infarction Database Initiative
  1. 1.Université de Lorraine, INSERM, Centre d’Investigation Clinique et Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
  2. 2.Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of MedicineUniversity of PortoPortoPortugal
  3. 3.Université de Lorraine, Institut Elie Cartan de Lorraine, UMR 7502Vandoeuvre-lès-NancyFrance
  4. 4.CNRS, Institut Elie Cartan de Lorraine, UMR 7502Vandoeuvre-lès-NancyFrance
  5. 5.Team BIGS, INRIAVillers-lès-NancyFrance
  6. 6.BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowScotland, UK
  7. 7.Department of MedicineUniversity of Michigan School of MedicineAnn ArborUSA
  8. 8.Department of CardiologyUniversity of Bergen, Stavanger University HospitalStavangerNorway

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