Body mass index and the risk of recurrent coronary events following acute myocardial infarction☆
Section snippets
Study population
The study setting was Group Health Cooperative, a health maintenance organization with >400,000 enrollees based in Washington state. Eligible patients included all enrollees who survived to hospital discharge following a first AMI during the period from July 1986 (women) or July 1989 (men) through December 1996. A potential incident AMI was identified by the International Classification of Disease 9th revision codes from the computerized discharge abstracts of the 2 Group Health Cooperative
Results
In the cohort of 2,541 patients who survived to hospital discharge following first AMI, 2/3 were either overweight (40.8%) with a BMI of 25 to 29.9, or obese (27.8%) with a BMI ≥30. Patients with greater BMIs tended to be younger, have a greater prevalence of diabetes, hypertension, or dyslipidemia, and were more frequently taking aspirin and β blockers (Table 1). During the 8,584 person-years of follow-up on the 2,541 subjects (median years of follow-up 3.0), there were 418 recurrent coronary
Discussion
In this inception cohort of persons who survived incident AMI, excess adiposity as estimated by BMI was associated with an increased risk of recurrent coronary events after adjustment for other clinical risk factors. This risk was especially evident among obese patients (BMI ≥30), whose risk appeared to increase with higher levels of obesity. The increased RR in the obese subgroup is of significant public health importance because these persons comprise over 1/4 of the cohort, a proportion
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This study was supported by grants HL53375, HL40628, and HL43201 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Manuscript received December 8, 2000; revised manuscript received and accepted March 30, 2001.