Skip to main content

Advertisement

SpringerLink
Log in

Impact of the body mass index on occurrence and outcome of acute ST-elevation myocardial infarction

  • ORIGINAL PAPER
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Obesity is a traditional risk factor for the development of cardiovascular disease. However, recent studies have described a better outcome of obese patients in the clinical course of acute coronary syndromes.

We investigated the impact of the body mass index (BMI) on occurrence and outcome of acute ST-elevation myocardial infarction (STEMI). Data of 10 534 consecutive patients with STEMI of the German MITRA PLUS registry were analyzed, comparing international classes of the BMI (obesity: BMI ≥ 30 kg/m2, overweight: 25–29.9 kg/m2, normal weight: 18.5–24.9 kg/m2).

STEMI occurred at a younger age in obese patients. The obese patients with first STEMI were 3 years younger than the normal weight patients with first STEMI (62.5 vs 65.7 years, p <0.0001).

After STEMI has occurred, the obese patients had the lowest hospital (6.0%) and long-term mortality (4.8%) of all compared BMI-groups. In a multivariate analysis, obesity compared to normal weight was associated with a trend of a reduced mortality without significance during the hospital course (OR 0.81, 95% CI 0.60–1.08) and with significance during follow-up (OR 0.56, 95% CI 0.40–0.79).

In conclusion, our data show that obesity is a risk factor of a manifestation of STEMI at a younger age compared to normal weight patients. After STEMI has occurred, obesity is associated with a trend of a lower mortality during the following clinical course. Therefore, the focus of prevention should be the reduction of obesity and metabolic syndrome in young people, to avoid the early occurrence of STEMI by primary prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hubert HB, Feinleib M, McNamara PM, Castelli WP (1983) Obesity is an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 67:968–977

    PubMed  CAS  Google Scholar 

  2. Ellis SG, Elliot J, Horrigan M, Raymond RE, Howell G (1996) Low-normal or excessive body mass index: newly identified risk factors for death and other complications with percutaneous coronary intervention. Am J Cardiol 78:642–664

    Article  PubMed  CAS  Google Scholar 

  3. Gurm HS, Whitlow PL, Kip KE; BARI Investigators (2002) The impact of body mass index on short- and longterm outcomes in patients undergoing coronary revascularization. Insights from the bypass angioplasty revascularization investigation (BARI). J Am Coll Cardiol 39(5):834–840

    Article  PubMed  Google Scholar 

  4. Gruberg L, Weissman NJ, Waksman R, Fuchs S, Deible R, Pinnow EE, Ahmed LM, Kent KM, Pichard AD, Suddath WO, Satler LF, Lindsay J (2002) The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol 39(4):578–584

    Article  PubMed  Google Scholar 

  5. Minutello RM, Chou ET, Hong MK, Bergman G, Parikh M, Iacovone F, Wong SC (2004) Impact of body mass index on in-hospital outcomes following percutaneous coronary intervention (report from the New York State Angioplasty Registry). Am J Cardiol 93(10):1229–1232

    Article  PubMed  Google Scholar 

  6. Sakamoto T, Kojima S, Ogawa H (2003) Increasing body mass index is paradoxically associated with decreased hospital mortality in patients with acute myocardial infarction: Possible involvement of an adipocyte-derived antiartherogenic protein adiponectin. Circulation 108(Suppl)17:3436

    Google Scholar 

  7. Eisenstein EL, McGuire DK, Bhapkar MV, Kristinsson A, Hochman JS, Kong DF, Califf RM, Van de Werf F, Yancy WS Jr, Newby LK (2005) Elevated body mass index and intermediate- term clinical outcomes after acute coronary syndromes. Am J Med 118(9):981–990

    Article  PubMed  Google Scholar 

  8. Iakobishvili Z, Danicek V, Porter A, Assali AR, Battler A, Hasdai D (2006) Is increased body mass index associated with a cardioprotective effect after ST-segment-elevation myocardial infarction? Acute Card Care 8(2):95–98

    PubMed  Google Scholar 

  9. Wells B, Gentry M, Ruiz-Arango A, Dias J, Landolfo CK (2006) Relation between body mass index and clinical outcome in acute myocardial infarction. Am J Cardiol 98(4):474–477

    Article  PubMed  Google Scholar 

  10. Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG, Mookadam F, Lopez-Jimenez F (2006) Association of body weight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet 368(9536):666–678

    Article  PubMed  Google Scholar 

  11. Mehta RH, Califf RM, Garg J, White HD, van de Werf F, Armstrong PW, Pieper KS, Topol EJ, Granger CB (2007) The impact of anthropomorphic indices on clinical outcomes in patients with acute ST-elevation myocardial infarction. Eur Heart J 28(4):415–424

    Article  PubMed  Google Scholar 

  12. Wienbergen H, Gitt AK, Schiele R, Juenger C, Heer T, Meisenzahl C, Limbourg P, Bossaller C, Senges J for the MITRA PLUS study group (2003) Comparison of clinical benefits of clopidogrel therapy in patients with acute coronary syndromes taking atorvastatin vs other statin therapies. Am J Cardiol 92:285–288

    Article  PubMed  CAS  Google Scholar 

  13. Rustige J, Schiele R, Burczyk U, Koch A, Gottwik M, Neuhaus KL, Tebbe U, Uebis R, Senges J (1997) The 60 min myocardial infarction project. Treatment and clinical outcome of patients with acute myocardial infarction in Germany. Eur Heart J 18:1438–1446

    PubMed  CAS  Google Scholar 

  14. Schuster S, Koch A, Burczyk U, Schiele R, Wagner S, Zahn R, Glunz HG, Heinrich F, Stuby K, Berg G, Voigtländer T, Gieseler U, Jakob M, Hauptmann P, Senges J for the MITRA study group (1997) Therapy of acute myocardial infarction, impact of clinical trials on clinical practice: The MITRA pilot phase. Z Kardiol 86:273–283

    Article  PubMed  CAS  Google Scholar 

  15. Wagner S, Schneider S, Schiele R, Fischer F, Dehn H, Grube R, Becker G, Baumgärtel B, Altmann E, Senges J (1999) Acute myocardial infarction in Germany between 1996 and 1998; therapy and intrahospital course: results of the myocardial infarction registry (MIR) in Germany. Z Kardiol 88:857–867

    Article  PubMed  CAS  Google Scholar 

  16. Lorenz H, Junger C, Seidl K, Gitt A, Schneider S, Schiele R, Wienbergen H, Winkler R, Gottwik M, Delius W, Senges J, Rauch B (2005) Do statins influence the prognostic impact of non-sustained ventricular tachycardia after ST-elevation myocardial infarction? Eur Heart J 26(11):1078–1085

    Article  PubMed  CAS  Google Scholar 

  17. York DA, Rössner S, Caterson I, Chen CM, James WPT, Kumanyika S, Martorell R, Vorster HH (2004) Prevention conference VII. Obesity, a worldwide epidemic related to heart disease and stroke: group I. Worldwide demographics of obesity. Circulation 110:e463–470

    Article  PubMed  Google Scholar 

  18. Lahiri K, Rettig-Ewen V, Böhm M, Laufs U (2007) Perceived psychosocial stress and cardiovascular risk factors in obese and non-obese patients. Clin Res Cardiol 96(6):365–374

    Article  PubMed  Google Scholar 

  19. Schächinger V, Britten MB, Zeiher AM (2006) Diabetes mellitus and coronary artery disease – a high risk combination. Clin Res Cardiol 95(Suppl 1):i18–i26

    Article  PubMed  Google Scholar 

  20. Reeves BC, Ascione R, Chamberlain MH, Angelini GD (2003) Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery. J Am Coll Cardiol 42(4):668–676

    Article  PubMed  Google Scholar 

  21. Galanos AN, Pieper CF, Kussin PS, Winchell MT, Fulkerson WJ, Harrell FE Jr, Teno JM, Layde P, Connors AF Jr, Phillips RS, Wenger NS (1997) Relationship of body mass index to subsequent mortality among seriously ill hospitalized patients. Crit Care Med 25:1962–1968

    Article  PubMed  CAS  Google Scholar 

  22. Tremblay A, Bandi V (2003) Impact of body mass index on outcomes following critical care. Chest 123(4):1202–1207

    Article  PubMed  Google Scholar 

  23. Kojima S, Funahashi T, Sakamoto T, Miyamoto S, Soejima H, Hokamaki J, Kajiwara I, Sugiyama S, Yoshimura M, Fujimoto K, Miyao Y, Suefuji H, Kitagawa A, Ouchi N, Kihara S, Matsuzawa Y, Ogawa H (2003) The variation of plasma concentrations of a novel, adipocyte derived protein, adiponectin, in patients with acute myocardial infarction. Heart 89:667

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Herzzentrum Ludwigshafen, Medizinische Klinik B, Department of Cardiology, Stiftung Institut für Herzinfarktforschung, Bremserstraße 79, 67063, Ludwigshafen, Germany

    Harm Wienbergen MD, Anselm Kai Gitt, Claus Juenger, Rudolf Schiele, Tobias Heer, Frank Towae & Jochen Senges

  2. Herzzentrum, Bad Krozingen, Germany

    Helmut Gohlke

Authors
  1. Harm Wienbergen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anselm Kai Gitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claus Juenger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rudolf Schiele
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tobias Heer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frank Towae
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Helmut Gohlke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jochen Senges
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the MITRA PLUS study group

Corresponding author

Correspondence to Harm Wienbergen MD.

Additional information

The MITRA PLUS study was supported by the Landesversicherungsanstalt, Rheinland Pfalz, Germany; the Ministerium für Arbeit, Soziales und Gesundheit, Rheinland- Pfalz, Germany; MSD Sharp & Dohme, Haar, Germany; Bristol-Myers Squibb, München, Germany; Aventis Pharma, Bad Soden, Germany; AstraZeneca, Wedel, Germany; Pfizer, Karlsruhe, Germany; Abbott, Ludwigshafen, Germany.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wienbergen, H., Gitt, A.K., Juenger, C. et al. Impact of the body mass index on occurrence and outcome of acute ST-elevation myocardial infarction. Clin Res Cardiol 97, 83–88 (2008). https://doi.org/10.1007/s00392-007-0585-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-007-0585-x

Key words

Search

Navigation