Document Type : Original Article(s)


Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran


Background: Obesity is strongly associated with increased cardiovascular diseases (CVD) and cardiovascular risk factors, such as diabetes mellitus, hypertension, and dyslipidemia. However, numerous studies have suggested the existence of an “obesity paradox” in which overweight and mildly obese patients often exhibit a better outcome than their leaner counterparts. Therefore, this study aimed to characterize the association between BMI and in-hospital and one-year outcomes.
Methods: This hospital-based research was conducted as a part of the Kermanshah STEMI Registry. Following the application of inclusion criteria, a total of 2,397 STEMI patients were evaluated. The data were collected using a standardized case report developed by the European Observational Registry Program (EORP). Body mass index (BMI) (kg/m2) was classified into underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), class I/mild obese (30–34.9), and class II/extreme obese (≥35) categories. The independent predictors of the in-hospital and one-year outcomes were assessed using multivariable logistic regression models. 
Results: Out of the 2397 patients, 43 (1.79%) were underweight, 934 (38.97%) were normal, 1038 (43.30%) were overweight, 322 (13.43%) were class I obese, and 60 (2.50%) were class II obese. The results of the crude analysis showed that class I obesity was protective against CV death (OR 0.50; 95% CI 0.30-0.84), MACE3 (MI, stroke, and death) (OR 0.47; 95% CI 0.29-0.76), and MACE5 (MACE3 plus unstable angina and heart failure) (OR 0.59; 95% CI 0.44-0.79). 
Conclusions: Multivariate adjustment eliminated the protective effect of class I obesity against death and MACE events. Therefore, it is possible that this protective effect does not exist and instead reflects the impact of confounding variables such as age.


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1.    WHO P. Health in the Americas, 2012 edn. Regional outlook and country profiles Washington, DC: Pan American Health Organization. 2012.
2.    Wolk R, Berger P, Lennon RJ, Brilakis ES, Somers VK. Body mass index: a risk factor for unstable angina and myocardial infarction in patients with angiographically confirmed coronary artery disease. Circulation. 2003;108(18):2206-11.
3.    Rimm EB, Stampfer MJ, Giovannucci E, Ascherio A, Spiegelman D, Colditz GA, et al. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. American journal of epidemiology. 1995;141(12):1117-27.
4.    Ades PA, Savage PD, editors. The obesity paradox: perception vs knowledge. Mayo Clinic Proceedings; 2010: Elsevier.
5.    Lavie CJ, Milani RV, Artham SM, Patel DA, Ventura HO. The obesity paradox, weight loss, and coronary disease. The American journal of medicine. 2009;122(12):1106-14.
6.    Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. The Lancet. 2006;368(9536):666-78.
7.    Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. Journal of the American college of cardiology. 2009;53(21):1925-32.
8.    Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. Guidelines: Editor’s choice: 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). European heart journal. 2016;37(29):2315.
9.    Siabani H, Davidson P, Siabani S, Gholizadeh L, Karim H, Najafi F, et al. The Kermanshah Acute Coronary Syndrome Registry: Rational and Design. Acta Scientific Medical Sciences. 2019.
10.    Thygesen K, Alpert JS, Jaffe A. Erratum: Third universal definition of myocardial infarction (Journal of the American College of Cardiology (2012) 60 (158-98. Journal of the American College of Cardiology. 2013;61(5):598.
11.    Das SR, Alexander KP, Chen AY, Powell-Wiley TM, Diercks DB, Peterson ED, et al. Impact of body weight and extreme obesity on the presentation, treatment, and in-hospital outcomes of 50,149 patients with ST-segment elevation myocardial infarction: results from the NCDR (National Cardiovascular Data Registry). Journal of the American College of Cardiology. 2011;58(25):2642-50.
12.    Kaneko H, Yajima J, Oikawa Y, Tanaka S, Fukamachi D, Suzuki S, et al. Obesity paradox in Japanese patients after percutaneous coronary intervention: an observation cohort study. Journal of cardiology. 2013;62(1):18-24.
13.    Lazzeri C, Valente S, Chiostri M, Attana P, Picariello C, Dini CS, et al. Impact of age on the prognostic value of body mass index in ST-Elevation myocardial infarction. Nutrition, Metabolism and Cardiovascular Diseases. 2013;23(3):205-11.
14.    Mobeirek AF, Al-Habib K, Al-Faleh H, Hersi A, Kashour T, Ullah A, et al. Absence of obesity paradox in Saudi patients admitted with acute coronary syndromes: insights from SPACE registry. Annals of Saudi medicine. 2014;34(1):38-45.
15.    Niedziela J, Hudzik B, Niedziela N, Gąsior M, Gierlotka M, Wasilewski J, et al. The obesity paradox in acute coronary syndrome: a meta-analysis. Springer; 2014.
16.    Angeras O, Albertsson P, Karason K, Ramunddal T, Matejka G, James S, et al., editors. Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). European Heart Journal; 2012.
17.    Neeland IJ, Das SR, Simon DN, Diercks DB, Alexander KP, Wang TY, et al. The obesity paradox, extreme obesity, and long-term outcomes in older adults with ST-segment elevation myocardial infarction: results from the NCDR. European Heart Journal-Quality of Care and Clinical Outcomes. 2017;3(3):183-91.
18.    Firman D, Arilaksono D, Ambari A, Radi B, Indriani S, Siagian S, et al. The obesity paradox: effect of body mass index on 2-years clinical outcome after primary percutaneous coronary intervention in Indonesia. European Review for Medical and Pharmacological Sciences. 2021;25(15):4973-82.
19.    Akin I, Tölg R, Hochadel M, Bergmann MW, Khattab AA, Schneider S, et al. No evidence of “obesity paradox” after treatment with drug-eluting stents in a routine clinical practice: results from the prospective multicenter German DES. DE (German Drug-Eluting Stent) Registry. JACC: Cardiovascular Interventions. 2012;5(2):162-9.
20.    Cepeda-Valery B, Pressman GS, Figueredo VM, Romero-Corral A. Impact of obesity on total and cardiovascular mortality—fat or fiction? Nature Reviews Cardiology. 2011;8(4):233-7.