Clinical Research
Cardiovascular Risk
Body Composition and Survival in Stable Coronary Heart Disease: Impact of Lean Mass Index and Body Fat in the “Obesity Paradox”

Presented in part as 2 abstract presentations to the American College of Cardiology Annual Scientific Sessions, April 2 to 5, 2011, New Orleans, Louisiana.
https://doi.org/10.1016/j.jacc.2012.05.037Get rights and content
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Objectives

Our goal was to determine the impact of lean mass index (LMI) and body fat (BF) on survival in patients with coronary heart disease (CHD).

Background

An inverse relationship between obesity and prognosis has been demonstrated (the “obesity paradox”) in CHD, which has been explained by limitations in the use of body mass index in defining body composition.

Methods

We studied 570 consecutive patients with CHD who were referred to cardiac rehabilitation, stratified as Low (≤25% in men and ≤35% in women) and High (>25% in men and >35% in women) BF and as Low (≤18.9 kg/m2 in men and ≤15.4 kg/m2 in women) and High LMI, and followed for 3 years for survival.

Results

Mortality is inversely related to LMI (p < 0.0001). Mortality was highest in the Low BF/Low LMI group (15%), which was significantly higher than in the other 3 groups, and lowest in the High BF/High LMI group (2.2%), which was significantly lower than in the other 3 groups. In Cox regression analysis as categoric variables, low LMI (hazard ratio [HR]: 3.1; 95% confidence interval [CI]: 1.3 to 7.1) and low BF (HR: 2.6; 95% CI: 1.1 to 6.4) predicted higher mortality, and as continuous variables, high BF (HR: 0.91; 95% CI: 0.85 to 0.97) and high LMI (HR: 0.81; 95% CI: 0.65 to 1.00) predicted lower mortality.

Conclusions

In patients with stable CHD, both LMI and BF predict mortality, with mortality particularly high in those with Low LMI/Low BF and lowest in those with High LMI/High BF. Determination of optimal body composition in primary and secondary CHD prevention is needed.

Key Words

body composition
coronary heart disease
obesity

Abbreviations and Acronyms

BF
body fat
BMI
body mass index
CHD
coronary heart disease
CI
confidence interval
COPD
chronic obstructive pulmonary disease
CV
cardiovascular
EF
ejection fraction
FFM
fat-free mass
HDL
high-density lipoprotein
HR
hazard ratio
LMI
lean mass index
OR
odds ratio
VO2
oxygen consumption

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All authors have reported they have no relationships relevant to the contents of this paper to disclose.