BMI and Clinical and Health Status Outcomes in Chronic Coronary Disease and Advanced Kidney Disease in ISCHEMIA-CKD. The American journal of medicine Mathew, R. O., Kretov, E. I., Huang, Z., Jones, P. G., Sidhu, M. S., O'Brien, S. M., Prokhorikhin, A. A., Rangaswami, J., Newman, J., Stone, G. W., Fleg, J. L., Spertus, J. A., Maron, D. J., Hochman, J. S., Bangalore, S. 2023


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