Obesity and cardiovascular events in patients with established coronary disease

Aims: To explore the association between obesity and major adverse coronary events (MACE) in patients with established coronary artery disease (CAD). Methods and results: The Prevention of Events with Angiotensin Converting Enzyme-Inhibition (PEACE) Trial randomized 8290 patients with stable CAD and left ventricular (LV) ejection fraction (EF) (LVEF) ≥0.40 to trandolapril or placebo and followed them for a median of 4.8 years. In PEACE patients who were non-diabetic at baseline (5693 men and 1171 women), we used proportional hazards models to conduct a post hoc analysis to examine whether obesity, defined as a body mass index (BMI) ≥30 kg/m², is an independent risk factor for the composite endpoint of MACE, defined as cardiovascular death, non-fatal myocardial infarction, coronary revascularization, or stroke. The analysis was conducted separately for men and women. The baseline prevalence of obesity was 28.5% in men and 28.9% in women. After adjusting for significant confounders, obesity was associated with MACE in men [hazard ratio (HR)=1.28, 95% CI 1.13-1.46, P<0.01], but not in women (HR=0.96, 95% CI 0.70-1.31, P=0.77). Further categorization of BMI showed a J-shaped association between BMI and MACE in the men, and no association in the women. Conclusion: In the presence of established CAD, obesity is associated with risk for MACE in men, but there is no support of an association in women. This finding requires further evaluation.