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Impact of neurohormonal blockade on association between body mass index and mortality.

Kennedy, Linn LU ; Anker, Stefan D; Kjekshus, John; Cook, Tom J and Willenheimer, Ronnie LU (2007) In International Journal of Cardiology 119. p.33-40
Abstract
The prognostic impact of body mass index ( BMI) in patients following acute myocardial infarction ( AMI) may be altered by neurohormonal blockade. Methods: The impact of neurohormonal blockade on the association between BMI and mortality was examined in 5548 patients following AMI ( CONSENSUS II), 50% receiving enalapril and 7% beta- blockade, and in 4367 patients with coronary artery disease ( CAD) ( 4S), 79% with prior AMI, 12% receiving ACEi and 67% beta- blockade. Median follow- up was 0.4 and 5.2 years, respectively. Patients were categorized into 4 BMI groups: Underweight, b22.00; normal- weight, 22.00 - 24.99; overweight, 25.00 - 29.99; obese, = 30.00 kg/ m(2). Multivariable analysis adjusted for demographics, patient history,... (More)
The prognostic impact of body mass index ( BMI) in patients following acute myocardial infarction ( AMI) may be altered by neurohormonal blockade. Methods: The impact of neurohormonal blockade on the association between BMI and mortality was examined in 5548 patients following AMI ( CONSENSUS II), 50% receiving enalapril and 7% beta- blockade, and in 4367 patients with coronary artery disease ( CAD) ( 4S), 79% with prior AMI, 12% receiving ACEi and 67% beta- blockade. Median follow- up was 0.4 and 5.2 years, respectively. Patients were categorized into 4 BMI groups: Underweight, b22.00; normal- weight, 22.00 - 24.99; overweight, 25.00 - 29.99; obese, = 30.00 kg/ m(2). Multivariable analysis adjusted for demographics, patient history, physical examination, biochemistry and medication. Results: CONSENSUS II: Overall, adjusted mortality ( n= 301) risk was similar across BMI groups. Comparing overweight with normalweight patients, the hazard ratios ( HRs) for mortality differed significantly ( P= 0.028) between patients randomized to placebo ( HR 1.41) and enalapril ( HR 0.75). 4S: Overall, adjusted mortality ( n= 421) risk was similar for normal- weight, overweight and obese patients. In a time- dependent analysis for drug use, comparing obese with normal- weight patients, the HRs for mortality differed significantly ( P= 0.047) between patients without ( HR 1.86) and those with ( HR 0.97) neurohormonal blockade. Conclusion: In patients after AMI or with CAD, high BMI was associated with increased mortality risk among patients not receiving neurohormonal blockade, but with decreased or neutral mortality risk among those receiving neurohormonal blockade. Tests for interaction indicate that neurohormonal blockade may attenuate the relationship between high BMI and increased mortality risk. Neurohormonal blockade may thus partly explain the so- called obesity paradox. (C) 2006 Elsevier Ireland Ltd. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute myocardial infarction, body mass index, neurohormonal blockade, mortality, coronary artery disease
in
International Journal of Cardiology
volume
119
pages
33 - 40
publisher
Elsevier
external identifiers
  • wos:000247732000007
  • scopus:34249293635
ISSN
0167-5273
DOI
10.1016/j.ijcard.2006.06.064
language
English
LU publication?
yes
id
a67ac218-dc32-4395-b728-21bb702a0723 (old id 162257)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17052777&dopt=Abstract
date added to LUP
2007-07-24 14:58:12
date last changed
2017-01-15 03:33:07
@article{a67ac218-dc32-4395-b728-21bb702a0723,
  abstract     = {The prognostic impact of body mass index ( BMI) in patients following acute myocardial infarction ( AMI) may be altered by neurohormonal blockade. Methods: The impact of neurohormonal blockade on the association between BMI and mortality was examined in 5548 patients following AMI ( CONSENSUS II), 50% receiving enalapril and 7% beta- blockade, and in 4367 patients with coronary artery disease ( CAD) ( 4S), 79% with prior AMI, 12% receiving ACEi and 67% beta- blockade. Median follow- up was 0.4 and 5.2 years, respectively. Patients were categorized into 4 BMI groups: Underweight, b22.00; normal- weight, 22.00 - 24.99; overweight, 25.00 - 29.99; obese, = 30.00 kg/ m(2). Multivariable analysis adjusted for demographics, patient history, physical examination, biochemistry and medication. Results: CONSENSUS II: Overall, adjusted mortality ( n= 301) risk was similar across BMI groups. Comparing overweight with normalweight patients, the hazard ratios ( HRs) for mortality differed significantly ( P= 0.028) between patients randomized to placebo ( HR 1.41) and enalapril ( HR 0.75). 4S: Overall, adjusted mortality ( n= 421) risk was similar for normal- weight, overweight and obese patients. In a time- dependent analysis for drug use, comparing obese with normal- weight patients, the HRs for mortality differed significantly ( P= 0.047) between patients without ( HR 1.86) and those with ( HR 0.97) neurohormonal blockade. Conclusion: In patients after AMI or with CAD, high BMI was associated with increased mortality risk among patients not receiving neurohormonal blockade, but with decreased or neutral mortality risk among those receiving neurohormonal blockade. Tests for interaction indicate that neurohormonal blockade may attenuate the relationship between high BMI and increased mortality risk. Neurohormonal blockade may thus partly explain the so- called obesity paradox. (C) 2006 Elsevier Ireland Ltd. All rights reserved.},
  author       = {Kennedy, Linn and Anker, Stefan D and Kjekshus, John and Cook, Tom J and Willenheimer, Ronnie},
  issn         = {0167-5273},
  keyword      = {acute myocardial infarction,body mass index,neurohormonal blockade,mortality,coronary artery disease},
  language     = {eng},
  pages        = {33--40},
  publisher    = {Elsevier},
  series       = {International Journal of Cardiology},
  title        = {Impact of neurohormonal blockade on association between body mass index and mortality.},
  url          = {http://dx.doi.org/10.1016/j.ijcard.2006.06.064},
  volume       = {119},
  year         = {2007},
}