Body Composition and Coronary Heart Disease Mortality-An Obesity or a Lean Paradox?

OBJECTIVE: To determine the combined effects of body mass index (BMI) and body fat (BF) on prognosis In coronary heart disease (CHD) to better understand the obesity paradox. PATIENTS AND METHODS: We studied 581 patients with CHD between January 1, 2000, and July 31, 2005, who were divided Into low (<25) and high BMI (>= 25), as well as low (>= 25% men and >= 35% women) and high BF (>= 25% in men and >35% in women). Four groups were analyzed by total mortality during the 3-year follow-up by National Death Index: low BF/low BMI (n=119), high BF/low BMI (n=26), low BF/high BMI (n=125), and high BF/high BMI (n=311). RESULTS: During the 3-year follow-up, mortality was highest In the low BF/low BMI group (11%), which was significantly (P<.001) higher than that in the other 3 groups (3.9%, 3.2%, and 2.6%, respectively); using the high BF/high BMI group as a reference, the low BF/low BMI group had a 4.24-fold increase in mortality (confidence interval [CI], 1.76-10.23; P=.001). In multivariate logistic regression for mortality, when entered individually, both high BMI (odds ratio [OR], 0.79; CI, 0.69-0.90) and high BF (OR, 0.89; CI, 0.82-0.95) as continuous variables were independent predictors of better survival, whereas low BMI (OR, 3.60; CI, 1.37-9.47) and low BF (OR, 3.52; CI, 1.34-9.23) as categorical variables were Independent predictors of higher mortality. CONCLUSION: Although both low BF and low BMI are Independent predictors of mortality In patients with CHD, only patients with combined low BF/low BMI appear to be at particularly high risk of mortality during follow-up. Studies are needed to determine optimal body composition In the secondary prevention of CHD.