Article

Obesity is frequent in type 2 diabetic patients with myocardial infarction
(MI) or established cardiovascular disease. Earlier studies suggest that elevated
body mass index (BMI) is associated with a favorable prognosis for persons with
established vascular disease. We sought to analyse the associations between
raised BMI and waist circumference with the 2-year event rate in type 2 diabetic
patients with established vascular disease. METHODS AND RESULTS: Patients from
the Reduction of Atherothrombosis for Continued Health (REACH) Registry, an
international, prospective cohort of patients at high risk of atherothrombosis,
were selected if they were diabetic and had established atherosclerotic arterial
disease (n = 19,579). The main outcomes after 2-year follow-up were: all-cause
death, cardiovascular death, MI, stroke, cardiovascular death/MI/stroke, and
cardiovascular death/MI/stroke/rehospitalization. The rates of all-cause death,
cardiovascular death, and cardiovascular death/MI/stroke decreased across
increasing BMI quintile categories, whereas the same rates were stable across
waist categories. The hazard ratios, adjusted for confounders, decreased
significantly with increasing BMI for all-cause death (p < 0.0001),
cardiovascular death (p = 0.0009), cardiovascular death/MI/stroke (p = 0.0004),
and all events (p = 0.002), but not for greater waist circumference. CONCLUSION:
There is an apparent obesity paradox (better outcome with increasing obesity)
when obesity is measured by BMI but not when measured by waist circumference in
diabetic subjects.

Langue : ANGLAIS