Body Mass Index and Clinical and Health Status Outcomes in Chronic Coronary Disease and Advanced Kidney Disease in the ISCHEMIA-CKD Trial

Roy O. Mathew, Department of Medicine, Loma Linda VA Health Care System, Loma Linda, Calif. Electronic address: roy.mathew@va.gov.
Evgeny I. Kretov, National Medical Research Center of Ministry of Health of Russia, Novosibirsk.
Zhen Huang, Duke Clinical and Research Institute and Duke University, Durham, NC.
Philip G. Jones, University of Missouri - Kansas City (UMKC)'s Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute.
Mandeep S. Sidhu, Albany Medical College, NY.
Sean M. O'Brien, Duke Clinical and Research Institute and Duke University, Durham, NC.
Aleksei A. Prokhorikhin, V.A. Almazov National Medical Research Centre, Saint Petersburg, Russia.
Janani Rangaswami, George Washington University School of Medicine, Washington, DC; Washington DC Veteran Affairs Medical Center.
Jonathan Newman, Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, NY.
Gregg W. Stone, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
Jerome L. Fleg, National Heart, Lung, and Blood Institute, Bethesda, MD.
John A. Spertus, University of Missouri - Kansas City (UMKC)'s Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute.
David J. Maron, Department of Medicine, Stanford University School of Medicine, Calif.
Judith S. Hochman, Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, NY.
Sripal Bangalore, Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, NY.

Document Type

Journal Article

Publication Date

11-3-2023

Journal

The American journal of medicine

DOI

10.1016/j.amjmed.2023.10.024

Keywords

Body Mass Index; Chronic Kidney Disease; Coronary Artery Disease; Death; Dialysis; Myocardial Infarction; Obesity; Obesity Paradox

Abstract

OBJECTIVE: This 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. METHODS: Baseline BMI was analyzed as both a continuous and categorical variable (< 25, ≥ 25 to < 30, ≥ 30 kg/m). 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. RESULTS: Body mass index ≥ 30 kg/m vs < 25 kg/m 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/m increase in BMI in unadjusted analysis. In multivariate analyses, a BMI ≥ 30 kg/m 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. CONCLUSIONS: In 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.

Department

Medicine

Link to Full Text

Share

COinS