The influence of body mass index on mortality and bleeding among patients with or at high-risk of atherothrombotic disease
Identifieur interne : 007C86 ( Main/Exploration ); précédent : 007C85; suivant : 007C87The influence of body mass index on mortality and bleeding among patients with or at high-risk of atherothrombotic disease
Auteurs : Koon-Hou Mak [Singapour] ; Deepak L. Bhatt [États-Unis] ; Mingyuan Shao [États-Unis] ; Steven M. Haffner [États-Unis] ; Christian W. Hamm [Allemagne] ; Graeme J. Hankey [Australie] ; S. Claiborne Johnston [États-Unis] ; Gilles Montalescot [France] ; Philippe Gabriel Steg [France] ; Steven R. Steinhubl ; Keith A. A. Fox [Royaume-Uni] ; Eric J. Topol [États-Unis]Source :
- European Heart Journal [ 0195-668X ] ; 2009-04.
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- Pascal (Inist)
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English descriptors
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Abstract
Aims We aimed to determine the relationship between body mass index (BMI) and cardiovascular events among individuals with or at-risk of atherothrombotic disease. Methods and results This was a prospective observational study of 15 532 patients enrolled in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial who were randomly assigned to clopidogrel or placebo, and followed-up for a median of 28 months for the occurrence of the primary endpoint (cardiovascular death, myocardial infarction, or stroke), all-cause mortality, and bleeding complications. Compared with the highest BMI quartile, the primary endpoint, cardiovascular, and all-cause mortality all occurred more frequently among patients in the lowest BMI quartile (about a third lower). The relationship between continuous BMI and adverse cardiovascular outcomes were presented as two linear spline terms with 29 kg/m2 as the cut-point for all-cause mortality. Lower BMI was associated with an increase in moderate and severe bleeding complications, largely accounted for by those receiving dual-antiplatelet agents with the highest tertile aspirin dose. Conclusion Adverse cardiovascular events and bleeding complications occurred more frequently among individuals with or at-risk for atherothrombotic disease and low BMI. Further studies should be directed to these patients to improve outcomes. The CHARISMA trial is registered with ClinicalTrials.gov, NCT00050817.
Url:
DOI: 10.1093/eurheartj/ehp037
Affiliations:
- Allemagne, Australie, France, Royaume-Uni, Singapour, États-Unis
- Californie, Massachusetts, Ohio, Texas, Écosse, Île-de-France
- Paris, Édimbourg
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Bhatt</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>VA Boston Healthcare System and Brigham and Women's Hospital, Boston, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Shao, Mingyuan" sort="Shao, Mingyuan" uniqKey="Shao M" first="Mingyuan" last="Shao">Mingyuan Shao</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Cleveland Clinic, Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Haffner, Steven M" sort="Haffner, Steven M" uniqKey="Haffner S" first="Steven M." last="Haffner">Steven M. 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Topol</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Scripps Translational Research Institute, La Jolla, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2009-04">2009-04</date><biblScope unit="volume">30</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="857">857</biblScope><biblScope unit="page" to="865">865</biblScope></imprint><idno type="ISSN">0195-668X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acetylsalicylic acid</term><term>Body mass index</term><term>Cardiology</term><term>Circulatory system</term><term>Clopidogrel</term><term>Disease</term><term>Epidemiology</term><term>Hemorrhage</term><term>High risk</term><term>Human</term><term>Mortality</term><term>Myocardial infarction</term><term>Nutritional status</term><term>Obesity</term><term>Prognosis</term><term>Stroke</term><term>Thrombosis</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Accident cérébrovasculaire</term><term>Acide acétylsalicylique</term><term>Appareil circulatoire</term><term>Cardiologie</term><term>Clopidogrel</term><term>Epidémiologie</term><term>Etat nutritionnel</term><term>Homme</term><term>Hémorragie</term><term>Indice masse corporelle</term><term>Infarctus du myocarde</term><term>Maladie</term><term>Mortalité</term><term>Obésité</term><term>Pronostic</term><term>Risque élevé</term><term>Thrombose</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term><term>Maladie</term><term>Mortalité</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract">Aims We aimed to determine the relationship between body mass index (BMI) and cardiovascular events among individuals with or at-risk of atherothrombotic disease. Methods and results This was a prospective observational study of 15 532 patients enrolled in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial who were randomly assigned to clopidogrel or placebo, and followed-up for a median of 28 months for the occurrence of the primary endpoint (cardiovascular death, myocardial infarction, or stroke), all-cause mortality, and bleeding complications. Compared with the highest BMI quartile, the primary endpoint, cardiovascular, and all-cause mortality all occurred more frequently among patients in the lowest BMI quartile (about a third lower). The relationship between continuous BMI and adverse cardiovascular outcomes were presented as two linear spline terms with 29 kg/m2 as the cut-point for all-cause mortality. Lower BMI was associated with an increase in moderate and severe bleeding complications, largely accounted for by those receiving dual-antiplatelet agents with the highest tertile aspirin dose. Conclusion Adverse cardiovascular events and bleeding complications occurred more frequently among individuals with or at-risk for atherothrombotic disease and low BMI. Further studies should be directed to these patients to improve outcomes. The CHARISMA trial is registered with ClinicalTrials.gov, NCT00050817.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>France</li><li>Royaume-Uni</li><li>Singapour</li><li>États-Unis</li></country><region><li>Californie</li><li>Massachusetts</li><li>Ohio</li><li>Texas</li><li>Écosse</li><li>Île-de-France</li></region><settlement><li>Paris</li><li>Édimbourg</li></settlement></list><tree><noCountry><name sortKey="Steinhubl, Steven R" sort="Steinhubl, Steven R" uniqKey="Steinhubl S" first="Steven R." last="Steinhubl">Steven R. Steinhubl</name></noCountry><country name="Singapour"><noRegion><name sortKey="Mak, Koon Hou" sort="Mak, Koon Hou" uniqKey="Mak K" first="Koon-Hou" last="Mak">Koon-Hou Mak</name></noRegion></country><country name="États-Unis"><region name="Massachusetts"><name sortKey="Bhatt, Deepak L" sort="Bhatt, Deepak L" uniqKey="Bhatt D" first="Deepak L." last="Bhatt">Deepak L. Bhatt</name></region><name sortKey="Haffner, Steven M" sort="Haffner, Steven M" uniqKey="Haffner S" first="Steven M." last="Haffner">Steven M. Haffner</name><name sortKey="Johnston, S Claiborne" sort="Johnston, S Claiborne" uniqKey="Johnston S" first="S. Claiborne" last="Johnston">S. Claiborne Johnston</name><name sortKey="Shao, Mingyuan" sort="Shao, Mingyuan" uniqKey="Shao M" first="Mingyuan" last="Shao">Mingyuan Shao</name><name sortKey="Topol, Eric J" sort="Topol, Eric J" uniqKey="Topol E" first="Eric J." last="Topol">Eric J. Topol</name></country><country name="Allemagne"><noRegion><name sortKey="Hamm, Christian W" sort="Hamm, Christian W" uniqKey="Hamm C" first="Christian W." last="Hamm">Christian W. Hamm</name></noRegion></country><country name="Australie"><noRegion><name sortKey="Hankey, Graeme J" sort="Hankey, Graeme J" uniqKey="Hankey G" first="Graeme J." last="Hankey">Graeme J. Hankey</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Montalescot, Gilles" sort="Montalescot, Gilles" uniqKey="Montalescot G" first="Gilles" last="Montalescot">Gilles Montalescot</name></region><name sortKey="Steg, Philippe Gabriel" sort="Steg, Philippe Gabriel" uniqKey="Steg P" first="Philippe Gabriel" last="Steg">Philippe Gabriel Steg</name></country><country name="Royaume-Uni"><region name="Écosse"><name sortKey="Fox, Keith A A" sort="Fox, Keith A A" uniqKey="Fox K" first="Keith A. A." last="Fox">Keith A. A. Fox</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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