Abstract

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.Baseline BMI was analyzed as both a continuous and categorical variable (<25, 25-<30, =30 kg/m2). Associations between BMI and the primary outcome of all-cause death or myocardial infarction (D/MI), as well as 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.BMI =30 kg/m2 versus <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 multivariable analyses, BMI =30 kg/m2 was marginally associated with D/MI (HR 1.43 (1.00, 2.04)) and greater dyspnea throughout follow up (P < 0.05 at all time points). Heterogeneity of treatment effect between baseline BMI was not evident for any outcome.In ISCHEMIA-CKD, 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.

View details for DOI 10.1016/j.amjmed.2023.10.024

View details for PubMedID 37925061