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NSTE ACS outcomes no worse in obese than nonobese patients
19 November 2008
Obese individuals with non-ST-segment elevation acute coronary syndromes (NSTE ACS) have no worse outcomes than nonobese, despite having multiple risk factors, report investigators from the SYNERGY trial.
The SYNERGY (Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors) trial was set up to study patients with NSTE ACS and other high-risk features.
Kenneth Mahaffey (Duke Clinical Research Institute, Durham, North Carolina, USA) and team investigated the relationship between outcome and body mass index (BMI) for the 9837 SYNERGY participants, who were randomly assigned to receive either enoxaparin or unfractionated heparin (UFH).
Detailed data for all patients was collected at baseline, after which patients were contacted at 30 days, 6 months, and 1 year, or after clinical events such as bleeding. BMI was measured at baseline and at 1 month.
Overall, almost a third of participants were obese (over 30 kg/m2) and, of these, nearly 10% had a BMI above 40 kg/m2. These individuals tended to be younger, but had more cardiovascular risk factors.
Initial analysis showed heavier individuals had lower risks for death, myocardial infarction, or inhospital bleeding at 30 days compared with lighter participants. But this association was lost after adjustment for confounders.
After adjustment, higher BMI was associated with lower 1-year mortality, but this only applied up to a BMI of about 30 kg/m2. The researchers found that more obese individuals had a trend toward worse 1-year mortality, but this was not statistically significant.
“Despite an apparent protective effect of obesity on long-term outcomes in patients who survive an acute event, the message needs to be made clear that obesity dramatically increases the risk for hypertension, diabetes, and hyperlipidemia, each of which contributes independently to the risk for coronary heart disease,” emphasize Mahaffey et al in the International Journal of Cardiology.
They add: “No interaction between the randomized treatment and obesity for efficacy and safety outcomes was observed across the range of BMI in this dataset.”
