Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

BackgroundPrognosis based on body fat percentage (BF%) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF% have a higher risk for major adverse cardiovascular events (MACEs) and that fat‐free...

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Autores principales:	Jose R. Medina‐Inojosa, Virend K. Somers, Randal J. Thomas, Nathalie Jean, Sarah M. Jenkins, Miguel Angel Gomez‐Ibarra, Marta Supervia, Francisco Lopez‐Jimenez
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2018
Materias:	adipose tissue cardiac rehabilitation coronary artery disease Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/e1e6540af68e4d748f610ee3335e8a41
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spelling	oai:doaj.org-article:e1e6540af68e4d748f610ee3335e8a412021-11-12T17:02:04ZAssociation Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox10.1161/JAHA.117.0075052047-9980https://doaj.org/article/e1e6540af68e4d748f610ee3335e8a412018-05-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.117.007505https://doaj.org/toc/2047-9980BackgroundPrognosis based on body fat percentage (BF%) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF% have a higher risk for major adverse cardiovascular events (MACEs) and that fat‐free mass is associated with better prognosis. Methods and ResultsWe included 717 patients referred to cardiac rehabilitation after coronary artery disease events or procedures who underwent air displacement plethysmography to assess BF%; 75% were men, with a mean age 61.4±11.4 years and a mean body mass index of 30±5.4 kg/m2. Follow‐up was performed using a record linkage system. Patients were classified in sex‐specific quartiles of BF% and fat‐free mass index. The composite outcome of MACEs included acute coronary syndromes, coronary revascularization, stroke, or death from any cause. After a median follow‐up of 3.9 years, 201 patients had a MACE. After adjusting for covariates, body mass index was not associated with MACEs (P=0.12). However, the risk of MACEs for those in the highest BF% quartile was nearly double when compared with those in the lowest quartile (hazard ratio, 1.89; 95% confidence interval, 1.30–2.77; P=0.0008). In contrast, fat‐free mass was inversely associated with MACEs. The risk of MACEs for those in the fourth fat‐free mass quartile was lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.35–0.82; P=0.004), when compared with those in the first quartile. ConclusionsIn patients with coronary artery disease, there is no obesity paradox when measuring BF% instead of body mass index. BF% is associated with a higher risk of MACEs, whereas fat‐free mass is associated with a lower risk of MACEs. Body mass index was not associated with MACEs.Jose R. Medina‐InojosaVirend K. SomersRandal J. ThomasNathalie JeanSarah M. JenkinsMiguel Angel Gomez‐IbarraMarta SuperviaFrancisco Lopez‐JimenezWileyarticleadipose tissuecardiac rehabilitationcoronary artery diseaseDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 7, Iss 10 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	adipose tissue cardiac rehabilitation coronary artery disease Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	adipose tissue cardiac rehabilitation coronary artery disease Diseases of the circulatory (Cardiovascular) system RC666-701 Jose R. Medina‐Inojosa Virend K. Somers Randal J. Thomas Nathalie Jean Sarah M. Jenkins Miguel Angel Gomez‐Ibarra Marta Supervia Francisco Lopez‐Jimenez Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox
description	BackgroundPrognosis based on body fat percentage (BF%) in patients with coronary artery disease has not been extensively studied. We tested the hypothesis that patients with coronary artery disease and increased BF% have a higher risk for major adverse cardiovascular events (MACEs) and that fat‐free mass is associated with better prognosis. Methods and ResultsWe included 717 patients referred to cardiac rehabilitation after coronary artery disease events or procedures who underwent air displacement plethysmography to assess BF%; 75% were men, with a mean age 61.4±11.4 years and a mean body mass index of 30±5.4 kg/m2. Follow‐up was performed using a record linkage system. Patients were classified in sex‐specific quartiles of BF% and fat‐free mass index. The composite outcome of MACEs included acute coronary syndromes, coronary revascularization, stroke, or death from any cause. After a median follow‐up of 3.9 years, 201 patients had a MACE. After adjusting for covariates, body mass index was not associated with MACEs (P=0.12). However, the risk of MACEs for those in the highest BF% quartile was nearly double when compared with those in the lowest quartile (hazard ratio, 1.89; 95% confidence interval, 1.30–2.77; P=0.0008). In contrast, fat‐free mass was inversely associated with MACEs. The risk of MACEs for those in the fourth fat‐free mass quartile was lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.35–0.82; P=0.004), when compared with those in the first quartile. ConclusionsIn patients with coronary artery disease, there is no obesity paradox when measuring BF% instead of body mass index. BF% is associated with a higher risk of MACEs, whereas fat‐free mass is associated with a lower risk of MACEs. Body mass index was not associated with MACEs.
format	article
author	Jose R. Medina‐Inojosa Virend K. Somers Randal J. Thomas Nathalie Jean Sarah M. Jenkins Miguel Angel Gomez‐Ibarra Marta Supervia Francisco Lopez‐Jimenez
author_facet	Jose R. Medina‐Inojosa Virend K. Somers Randal J. Thomas Nathalie Jean Sarah M. Jenkins Miguel Angel Gomez‐Ibarra Marta Supervia Francisco Lopez‐Jimenez
author_sort	Jose R. Medina‐Inojosa
title	Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox
title_short	Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox
title_full	Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox
title_fullStr	Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox
title_full_unstemmed	Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox
title_sort	association between adiposity and lean mass with long‐term cardiovascular events in patients with coronary artery disease: no paradox
publisher	Wiley
publishDate	2018
url	https://doaj.org/article/e1e6540af68e4d748f610ee3335e8a41
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Association Between Adiposity and Lean Mass With Long‐Term Cardiovascular Events in Patients With Coronary Artery Disease: No Paradox

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