• Roy O Mathew, Evgeny I Kretov, Zhen Huang, Philip G Jones, Mandeep S Sidhu, Sean M O'Brien, Aleksei A Prokhorikhin, Janani Rangaswami, Jonathan Newman, Gregg W Stone, Jerome L Fleg, John A Spertus, David J Maron, Judith S Hochman, Sripal Bangalore, and ISCHEMIA-CKD Research Group.
• Department of Medicine, Loma Linda VA Health Care System, Loma Linda, Calif. Electronic address: roy.mathew@va.gov.
• Am. J. Med. 2024 Feb 1; 137 (2): 163171.e24163-171.e24.

ObjectiveThis study aimed to assess whether an obesity paradox (lower event rates with higher body mass index [BMI]) exists in participants with advanced chronic kidney disease (CKD) and chronic coronary disease in the International Study of Comparative Health Effectiveness of Medical and Invasive Approaches (ISCHEMIA)-CKD, and whether BMI modified the effect of initial treatment strategy.MethodsBaseline BMI was analyzed as both a continuous and categorical variable (< 25, ≥ 25 to < 30, ≥ 30 kg/m2). Associations between BMI and the primary outcome of all-cause death or myocardial infarction (D/MI), and all-cause death, cardiovascular death, and MI individually were estimated. Associations with health status were also evaluated using the Seattle Angina Questionnaire-7, the Rose Dyspnea Scale, and the EuroQol-5D Visual Analog Scale.ResultsBody mass index ≥ 30 kg/m2 vs < 25 kg/m2 demonstrated increased risk for MI (hazard ratio [HR] [95% confidence interval] = 1.81 [1.12-2.92]) and for D/MI (HR 1.45 [1.06-1.96]) with a HR for MI of 1.22 (1.05-1.40) per 5 kg/m2 increase in BMI in unadjusted analysis. In multivariate analyses, a BMI ≥ 30 kg/m2 was marginally associated with D/MI (HR 1.43 [1.00-2.04]) and greater dyspnea throughout follow-up (P < .05 at all time points). Heterogeneity of treatment effect between baseline BMI was not evident for any outcome.ConclusionsIn the ISCHEMIA-CKD trial, an obesity paradox was not detected. Higher BMI was associated with worse dyspnea, and a trend toward increased D/MI and MI risk. Larger studies to validate these findings are warranted.Published by Elsevier Inc.

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