Moderate overweight is beneficial and severe obesity detrimental for patients with documented atherosclerotic heart disease

Aziza Azimi, Mette Gitz Charlot, Christian Tobias Torp-Pedersen, Gunnar Hilmar Gislason, Lars Valeur Køber, Lisette Okkels Jensen, Per Thayssen, Jan Ravkilde, Hans-Henrik Tilsted, Jens Flensted Lassen, Leif Thuesen

Research output: Contribution to journalJournal articleResearchpeer-review


Objective: Obesity is paradoxically associated with enhanced survival in patients with established cardiovascular disease. We explored this paradox further by examining the influence of obesity on survival in patients with verified atherosclerotic heart disease. Design and patients: This retrospective registry based cohort study included all patients from the Western Denmark Heart Registry with coronary atherosclerosis confirmed by coronary angiography from January 2000 to December 2010. Patients were divided into eight groups according to body mass index (BMI) based on WHO BMI classification. Setting: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark. Results: The study included 37 573 patients (70.7% men) with a mean age of (66.3±11.1) years. During the 11 years of follow-up, 5866 (15.6%) patients died. Multivariable analysis confirmed that the risk of death was the lowest among the preobese patients (27.5≤BMI<30 kg/m 2) with adjusted HR of 0.82 (95% CI 0.71 to 0.95; p=0.008) and increased with both low (BMI<18.50 kg/m 2) and very high (BMI>40 kg/m 2) BMI, HR 2.04 (95% CI 1.63 to 2.57; p<0.001) and HR 1.35 (95% CI 1.05 to 1.72; p<0.01), respectively. Also the normal weight class I (18.5≤BMI<23 kg/m 2) had a significant risk of mortality HR 1.28 (95% CI 1.13 to 1.45; p<0.001). Obese classes I and II did not differ from the reference group (23≤BMI<25 kg/m 2). Conclusions Overweight atherosclerotic heart disease patients have improved survival compared with normal weight patients. Underweight and severely obese patients have increased mortality. Our results lean more towards an overweight paradox than an obesity paradox.

Original languageEnglish
Issue number9
Pages (from-to)655-660
Number of pages6
Publication statusPublished - May 2013


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