0
Original Research: COPD |

The Obesity Paradox in Patients With Peripheral Arterial Disease

Wael Galal, MD; Yvette R. B. M. van Gestel, MSc; Sanne E. Hoeks, MSc; Don D. Sin, MD, FCCP; Tamara A. Winkel, MD; Jeroen J. Bax, MD; Hence Verhagen, MD; Adel M. M. Awara, MD; Jan Klein, MD; Ron T. van Domburg, PhD; Don Poldermans, MD
Author and Funding Information

*From the Departments of Anesthesiology (Drs. Galal, Klein, and Poldermans, Ms. van Gestel, and Ms. Hoeks), Surgery (Drs. Winkel and Verhagen), and Cardiology (Dr. van Domburg), Erasmus Medical Center, Rotterdam, the Netherlands; the James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research (Dr. Sin), St. Paul's Hospital & University of British Columbia, Vancouver, BC, Canada; the Department of Cardiology (Dr. Bax), Leiden Medical Centre, Leiden, the Netherlands; and the Department of Anesthesiology (Dr. Awara), Tanta Faculty of Medicine, Tanta, Egypt.

Correspondence to: Don Poldermans, MD, Erasmus Medical Center, Gravendijkwal 230, Room H-921, 3015 CE Rotterdam, the Netherlands; e-mail: d.poldermans@erasmusmc.nl


For editorial comment see page 896

Ms. van Gestel and Ms. Hoeks are supported by an unrestricted research grant from the foundation “Lijf en Leven,” the Netherlands.

Dr. Galal has received a postdoctoral research scholarship to study in the Netherlands. Ms. van Gestel, Ms. Hoeks, and Drs. Sin, Winkel, Bax, Verhagen, Awara, Klein, van Domburg, and Poldermans have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(5):925-930. doi:10.1378/chest.08-0418
Text Size: A A A
Published online

Background:  Cardiac events are the predominant cause of late mortality in patients with peripheral arterial disease (PAD). In these patients, mortality decreases with increasing body mass index (BMI). COPD is identified as a cardiac risk factor, which preferentially affects underweight individuals. Whether or not COPD explains the obesity paradox in PAD patients is unknown.

Methods:  We studied 2,392 patients who underwent major vascular surgery at one teaching institution. Patients were classified according to COPD status and BMIs (ie, underweight, normal, overweight, and obese), and the relationship between these variables and all-cause mortality was determined using a Cox regression analysis. The median follow-up period was 4.37 years (interquartile range, 1.98 to 8.47 years).

Results:  The overall mortality rates among underweight, normal, overweight, and obese patients were 54%, 50%, 40%, and 31%, respectively (p < 0.001). The distribution of COPD severity classes showed an increased prevalence of moderate-to-severe COPD in underweight patients. In the entire population, BMI (continuous) was associated with increased mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94 to 0.98). In addition, patients who were classified as being underweight were at increased risk for mortality (HR, 1.42; 95% CI, 1.00 to 2.01). However, after adjusting for COPD severity the relationship was no longer significant (HR, 1.29; 95% CI, 0.91 to 1.93).

Conclusions:  The excess mortality among underweight patients was largely explained by the overrepresentation of individuals with moderate-to-severe COPD. COPD may in part explain the “obesity paradox” in the PAD population.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543