Overweight and obese cardiac patients have better prognosis despite reporting worse perceived health and more conventional risk factors

摘要

Objective: The obesity paradox in patients with cardiovascular disease (CVD) remains unexplained. We examined the role of self-rated health, behavioral and objectively assessed risk factors, in order to further explore mechanisms that might influence the association between body mass index (BMI) and mortality in CVD patients. Methods: Participants were 4417 community dwelling adults from the Health Survey for England and Scottish Health Survey from 1994-2004 (aged 65.9. ±. [Standard deviation (SD) 10.6. yrs], 56.2% men) with clinically diagnosed CVD at baseline. Results: There were 570 CVD and 1441 and all-cause deaths, over an average of 7.3yrs of follow-up. Overweight and obese patients reported worse self-rated health, more co-morbidities and biological risk factors. However, compared with non-obese participants (BMI25kg/m2), a lower risk of all-cause mortality was observed in overweight (BMI 2530kg/m2) (Hazard ratio [HR]=0.73, 95% confidence intervals [CI], 0.64-0.82), and obese (BMI≥30kg/m2) participants (HR=0.84, 95% CI, 0.73-0.97) after adjustment for age, sex, smoking, physical activity, and various co-morbidities. Conclusions: Overweight and obese CVD patients have better prognosis despite reporting worse health, more co-morbidities and risk factors, and poorer adherence to lifestyle advice.