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Dysmetabolic status, and not obesity per se, is associated with increased cardiovascular mortality in patients with stable coronary disease
Authors:
C Daly, KM Fox, M Bertrand1, R Ferrari2, W Remme3, M Simoons4, Royal Brompton Hospital - London - United Kingdom, 1INSERM - Lille - France, 2Arcispidele S Anna - Ferrara - Italy, 3STICARES - Rhoon - Netherlands, 4Thoraxcenter - Rotterdam - Netherlands,
On behalf: The EUROPA investigators
Topic(s):
CAD and diabetes
Angina pectoris, stable
Prognosis
The metabolic syndrome(MetSyn) predicts adverse cardiovascular (CV) outcome. Increasing levels of obesity are closely linked with increasing prevalence of MetSyn but it is not clear if obesity per se has a negative effect on CV mortality. We investigated this in 8397 patients with known coronary artery disease(CAD)in EUROPA, a trial of the effects of perindopril on CV events in stable CAD with 4.2 year follow up.
Patients were categorised as having dysmetabolic status if they had either diabetes (DM) or MetSyn. MetSyn was defined by the presence of at least 3 of the following: BP >130/85 or antihypertensive medication; HDL <1.0 mmol/l (male), and <1.3 mmol/l (female); Body Mass Index > 30; fasting plasma glucose >6.1 mmol/l. The population was also stratified according to BMI, with a BMI < 25 considered normal weight, BMI 25-30 overweight and BMI > 30 obese.
MetSyn without DM was identified in 1183 patients(14%) and DM in 1502(18%). Stratified by BMI and dysmetabolic status the probability of CV death was increased by dysmetabolic status, but not by overweight or obesity (Fig). With normal weight without dysmetabolic status as reference, the RR of CV death associated with obesity and dysmetabolic status was 2.4 [95% CI 1.5-3.7], p<0.001, overweight and dysmetabolic status was 3.0 [95% CI 1.9-4.7], p<0.001, and normal weight and dysmetabolic status was 4.1 [95% CI 2.9-6.9] p<0.001. Patients who were overweight or obese without DM or MetSyn were not at increased risk of CV death. Obesity is not an independent predictor of CV death in patients with CAD. All patients with CAD should be screened for DM and MetSyn not just those who are overweight or obese, as normal weight individuals with dysmetabolic features are at particularly high risk of CV death.
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