Meta-analysis of the Relation of Body Mass Index to Cardiovascular Outcomes in Patients Receiving Intensive Low-Density Lipoprotein Cholesterol Lowering Therapy - 10/02/20
, Muhammad U. Khan, MD a, Haris Riaz, MD b, Paolo Raggi, MD c, Shahul Valavoor, MD a, Muhammad Zia Khan, MD a, Michalina Kołodziejczak, MD d, e, Muhammad Shahzeb Khan, MD f, Troy Krupica, MD a, Mohamad Alkhouli, MD g, Eliano P. Navarese, MD, PhD d, e, hRésumé |
The impact of body mass index (BMI) on cardiovascular outcomes in patients receiving intensive low-density lipoprotein cholesterol (LDL-C) lowering therapy is uncertain. We performed meta-analysis of 29 randomized controlled trials using PubMed, Embase, and CENTRAL through April 2019. Therapies were grouped as more intensive LDL-C lowering therapy (statins, ezetimibe + statin or PCSK9 inhibitors) and less intensive LDL-C lowering therapy (less potent active control or placebo). Random effects meta-regressions and meta-analyses were performed to evaluate association of BMI with cardiovascular endpoints. In 265,766 patients, for every 1 kg/m2 increase in BMI, more intensive therapy compared with less intensive therapy was associated with hazard ratio (HR) of 1.07 for cardiovascular mortality (95% confidence interval 1.02 to 1.13); HR of 1.03 for all-cause mortality (0.99 to 1.06) HR of 1.06 for myocardial infarction (1.02 to 1.09), HR of 1.08 (1.03 to 1.12) for revascularization and HR of 1.04 for MACE (1.01 to 1.07). Meta-analysis showed that patients with BMI <25 kg/m2 had the highest risk reduction in mortality and cardiovascular outcomes compared with patients with BMI ≥30 kg/m2 (p-interaction ≤0.05). In conclusion, patients with normal BMI treated with intensive LDL-C lowering regimens may derive a larger clinical benefit compared with patients with larger BMI. The results could be due to the higher mortality rate of obese patients that may artificially lower the efficacy of therapy, or due to a true therapeutic limitation in these patients.
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| Author contribution: Safi U. Khan: Conceptualization, Methodology, Software, Writing- Original draft preparation; Muhammad U. Khan, Shahul Valavoor, Muhammad Zia Khan and Michalina Kołodziejczak: Data curation, Software; Haris Riaz, Paolo Raggi Muhammad Shahzeb Khan, Troy Krupica, Mohamed Alkhouli; Eliano P. Navarese: Writing- Reviewing and Editing. |
Vol 125 - N° 5
P. 727-734 - mars 2020 Retour au numéro
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