Relationship between body mass index, antidiabetic agents, and midterm mortality in patients with both type 2 diabetes mellitus and acute coronary syndrome

Chien Boon Jong, Hung Yuan Li, Shin Liang Pan, Mu Yang Hsieh, Fang Ying Su, Kuan Chun Chen, Wei Hsian Yin, Shih-Hung Chan, Yen Wen Wu, Kuo Yung Wang, Kuan Cheng Chang, Juey Jen Hwang, Chih Cheng Wu

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article numbere011215
JournalJournal of the American Heart Association
Volume8
Issue number7
DOIs
Publication statusPublished - 2019 Jan 1

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Acute Coronary Syndrome
Hypoglycemic Agents
Type 2 Diabetes Mellitus
Body Mass Index
Mortality
Obesity
Insulin
Weights and Measures
Observational Studies
Diabetes Mellitus
Therapeutics
Regression Analysis
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Jong, Chien Boon ; Li, Hung Yuan ; Pan, Shin Liang ; Hsieh, Mu Yang ; Su, Fang Ying ; Chen, Kuan Chun ; Yin, Wei Hsian ; Chan, Shih-Hung ; Wu, Yen Wen ; Wang, Kuo Yung ; Chang, Kuan Cheng ; Hwang, Juey Jen ; Wu, Chih Cheng. / Relationship between body mass index, antidiabetic agents, and midterm mortality in patients with both type 2 diabetes mellitus and acute coronary syndrome. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 7.
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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.",
author = "Jong, {Chien Boon} and Li, {Hung Yuan} and Pan, {Shin Liang} and Hsieh, {Mu Yang} and Su, {Fang Ying} and Chen, {Kuan Chun} and Yin, {Wei Hsian} and Shih-Hung Chan and Wu, {Yen Wen} and Wang, {Kuo Yung} and Chang, {Kuan Cheng} and Hwang, {Juey Jen} and Wu, {Chih Cheng}",
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Relationship between body mass index, antidiabetic agents, and midterm mortality in patients with both type 2 diabetes mellitus and acute coronary syndrome. / Jong, Chien Boon; Li, Hung Yuan; Pan, Shin Liang; Hsieh, Mu Yang; Su, Fang Ying; Chen, Kuan Chun; Yin, Wei Hsian; Chan, Shih-Hung; Wu, Yen Wen; Wang, Kuo Yung; Chang, Kuan Cheng; Hwang, Juey Jen; Wu, Chih Cheng.

In: Journal of the American Heart Association, Vol. 8, No. 7, e011215, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Relationship between body mass index, antidiabetic agents, and midterm mortality in patients with both type 2 diabetes mellitus and acute coronary syndrome

AU - Jong, Chien Boon

AU - Li, Hung Yuan

AU - Pan, Shin Liang

AU - Hsieh, Mu Yang

AU - Su, Fang Ying

AU - Chen, Kuan Chun

AU - Yin, Wei Hsian

AU - Chan, Shih-Hung

AU - Wu, Yen Wen

AU - Wang, Kuo Yung

AU - Chang, Kuan Cheng

AU - Hwang, Juey Jen

AU - Wu, Chih Cheng

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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U2 - 10.1161/JAHA.118.011215

DO - 10.1161/JAHA.118.011215

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VL - 8

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

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