Relationship between body mass index, antidiabetic agents, and midterm mortality in patients with both type 2 diabetes mellitus and acute coronary syndrome
Journal
Journal of the American Heart Association
Journal Volume
8
Journal Issue
7
Pages
e011215
Date Issued
2019
Author(s)
Su F.-Y.
Chen K.-C.
Yin W.-H.
Chan S.-H.
Wang K.-Y.
Chang K.-C.
Abstract
Background-The aim of this study was to determine the influence of various antidiabetic therapies on the relationship between body mass index and all-cause mortality in patients with diabetes mellitus and acute coronary syndrome. Methods and Results-This was a prospective, observational study comprising 1193 patients diagnosed with type 2 diabetes mellitus and acute coronary syndrome. The patients were stratified into 4 body mass index categories, and their mortality rates were compared using time-dependent Cox regression analysis using normal weight (body mass index, 18.5-23.9) as the reference. Subsequently, the influence of antidiabetic therapies on the association between BMI and mortality were analyzed. Seventy-four patients (6.2%) died over 2 years of follow-up. The mortality rate was lowest in the class I obese group (3.35%) and highest in the normal-weight group (9.67%). After adjusting for covariates, class I obesity paradoxically remained significantly protective against mortality compared with normal weight (hazard ratio, 0.141; P=0.049); interaction term analysis showed that insulin therapy influenced this “obesity paradox” (P=0.045). When the patients were stratified by insulin use, the protective effect of obesity disappeared in the insulin-treated patients but persisted in the non-insulin-treated patients. Conclusions-In patients with type 2 diabetes mellitus and acute coronary syndrome, the relationship between body mass index and mortality rate is U-shaped, with class I obesity representing the nadir and normal weight the peak. The protective effect of obesity disappeared in patients treated with insulin. ? 2019 The Authors.
SDGs
Other Subjects
angiotensin 2 receptor antagonist; antidiabetic agent; antithrombocytic agent; beta adrenergic receptor blocking agent; dipeptidyl carboxypeptidase inhibitor; dipeptidyl peptidase IV inhibitor; hydroxymethylglutaryl coenzyme A reductase inhibitor; insulin; insulin sensitizing agent; meglitinide; metformin; pioglitazone; sulfonylurea; antidiabetic agent; acute coronary syndrome; adult; adverse outcome; aged; all cause mortality; Article; body mass; body weight; cohort analysis; controlled study; disease association; drug use; female; follow up; human; insulin treatment; major clinical study; male; mortality rate; non insulin dependent diabetes mellitus; obesity; observational study; priority journal; prospective study; treatment response; acute coronary syndrome; body mass; cause of death; comorbidity; middle aged; mortality; non insulin dependent diabetes mellitus; non ST segment elevation myocardial infarction; obesity; proportional hazards model; protection; risk factor; ST segment elevation myocardial infarction; unstable angina pectoris; Acute Coronary Syndrome; Aged; Angina, Unstable; Body Mass Index; Cause of Death; Comorbidity; Diabetes Mellitus, Type 2; Female; Humans; Hypoglycemic Agents; Male; Middle Aged; Mortality; Non-ST Elevated Myocardial Infarction; Obesity; Proportional Hazards Models; Prospective Studies; Protective Factors; Risk Factors; ST Elevation Myocardial Infarction
Publisher
American Heart Association Inc.
Type
journal article