• Thais Coutinho, Kashish Goel, Daniel Corrêa de Sá, Charlotte Kragelund, Alka M Kanaya, Marianne Zeller, Jong-Seon Park, Lars Kober, Christian Torp-Pedersen, Yves Cottin, Luc Lorgis, Sang-Hee Lee, Young-Jo Kim, Randal Thomas, Véronique L Roger, Virend K Somers, and Francisco Lopez-Jimenez.
• Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
• J. Am. Coll. Cardiol. 2011 May 10; 57 (19): 1877-86.

ObjectivesThe 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.BackgroundThe question of which measure of obesity better predicts survival in patients with CAD is controversial.MethodsWe searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6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.ResultsFrom 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 We obtained individual subject data from 4, adding unpublished data from a cardiac rehabilitation cohort.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).ConclusionsIn subjects with CAD, including those with normal and high BMI, central obesity but not BMI is directly associated with mortality.Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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