Central Obesity and Survival in Subjects With Coronary Artery Disease A Systematic Review of the Literature and Collaborative Analysis With Individual Subject Data

作者：Coutinho Thais; Goel Kashish; de Sa Daniel Correa; Kragelund Charlotte; Kanaya Alka M; Zeller Marianne; Park Jong Seon; Kober Lars; Torp Pedersen Christian; Cottin Yves; Lorgis Luc; Lee Sang Hee; Kim Young Jo; Thomas Randal; Roger Veronique L; Somers Virend K; Lopez Jimenez Francisco^*

来源：Journal of the American College of Cardiology, 2011, 57(19): 1877-1886.

DOI：10.1016/j.jacc.2010.11.058

• central obesity
• coronary artery disease
• mortality
• waist circumference
• waist-hip ratio

Objectives The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients.
Background The question of which measure of obesity better predicts survival in patients with CAD is controversial.
Methods We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months.
Results From 2,188 studies found, 6 met inclusion criteria. We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort. A variable called "central obesity" was created on the basis of tertiles of WHR or WC. Cox-proportional hazards were adjusted for age, sex, and confounders. The final sample consisted of 15,923 subjects. There were 5,696 deaths after a median follow-up of 2.3 (interquartile range 0.5 to 7.4) years. Central obesity was associated with mortality (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.58 to 1.83), whereas BMI was inversely associated with mortality (HR: 0.64, 95% CI: 0.59 to 0.69). Central obesity was also associated with higher mortality in the subset of subjects with normal BMI (HR: 1.70, 95% CI: 1.52 to 1.89) and BMI >= 30 kg/m(2) (HR: 1.93, 95% CI: 1.61 to 2.32).
Conclusions In subjects with CAD, including those with normal and high BMI, central obesity but not BMI is directly associated with mortality.

• 出版日期2011-5-10