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High BMI After Coronary Event Predicts a Shorter Life Span.

ATLANTA -- Obese individuals who develop an acute coronary syndrome do so at a younger age and have a briefer life expectancy than do leaner patients with heart disease, according to Eric L. Eisenstein, D.B.A.

Obese individuals also spend more years living with significant coronary heart disease, racking up more hospitalizations and higher medical bills than their lean counterparts who have unstable angina or a myocardial infarction, Dr. Eisenstein said at the annual scientific sessions of the American Heart Association.

These were the key findings of his retrospective study of obesity's impact on life expectancy in 9,407 patients who underwent coronary angiography following an acute coronary syndrome in 1986-97 at Duke University, Durham, N.C.

The AHA has labelled obesity a major risk factor for the development of coronary disease. Dr. Eisenstein sought to look at a somewhat different issue: What is the quantitative impact of obesity on life expectancy once patients already have had an acute coronary event?

The results showed body mass index to be an independent predictor of life expectancy following an acute coronary syndrome. A higher BMI at the time of a first episode of unstable angina or MI was bad news even after controlling for lipids, hypertension, diabetes, and other well-established major cardiovascular risk factors, said Dr. Eisenstein of the university.

At the time of their coronary catheterization, 31% of the nearly 10,000 subjects were of normal weight, 42% were overweight as defined by a BMI of at least 25 but less than 30, and 20% had higher BMIs and were considered to be obese.

Patients who were overweight but not obese at diagnostic catheterization averaged 62 years of age, 4 years younger than normal-weight patients. Obese patients were, on average, 7-9 years younger; the greater their obesity the younger they were at diagnosis.

A life-expectancy predictor model indicated that obese patients also averaged a 1- to 4-year shorter mean life expectancy than did the normal-weight group, again depending upon their degree of obesity.

"The typical normal-weight patient would be expected to have 14 years of illness after diagnosis; overweight patients had 16 years, and the obese had 17-18 years. This meant obese patients would spend 3-4 more years with significant coronary artery disease than normal-weight patients," Dr. Eisenstein noted.

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Publication:Family Practice News
Article Type:Brief Article
Date:Mar 1, 2000
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