Body mass index and cardiovascular outcomes in patients with acute coronary syndrome by diabetes status: the obesity par
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ORIGINAL INVESTIGATION
Cardiovascular Diabetology Open Access
Body mass index and cardiovascular outcomes in patients with acute coronary syndrome by diabetes status: the obesity paradox in a Korean national cohort study Se‑Jun Park1,4†, Kyoung Hwa Ha2,3† and Dae Jung Kim2,3*
Abstract Background: The “obesity paradox” has not been elucidated in the long-term outcomes of acute coronary syndrome (ACS). We investigated the association between obesity and cardiovascular (CV) outcomes in ACS patients with and without diabetes. Methods: We identified 6978 patients with ACS aged 40–79 years from the Korean National Health Insurance Service-Health Screening Cohort between 2002 and 2015. Baseline body mass index (BMI) was categorized as under‑ weight ( 98% of the entire Korean population. The NHIS-Health Screening Cohort is a dataset with a random sample of 10% of the population aged 40–79 years who completed a National Health Screening test in 2002 or 2003. The database provides information regarding the demographic characteristics, medical claims (including diagnostic and treatment codes), health surveys, physical examinations, and biochemical tests of 514,866 participants. The diagnostic
Fig. 1 Flowchart of the study population. ACS, acute coronary syndrome
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codes are based on the International Classification of Diseases, 10th revision (ICD-10) [12]. This study included patients who were first hospitalized with ACS (ICD-10 codes: I20–22) between 2002 and 2015. Patients with a previous history of cancer or outpatient diagnosis with ACS before the first hospitalization were excluded. Patients whose data were unavailable for analysis or not received the health screening test within 1 year before the first hospitalization for ACS were also excluded (Fig. 1). The follow-up period was defined as the time from the index date (date of hospital discharge) to the each outcome event, date of death, or end of the study period (December 31, 2015), whichever came first. The study protocol was reviewed and approved by the Institutional Review Board of Ajou University Hospital (AJIRB-MED-EXP-17-253). The requirement for informed consent was waived as the data in this database were de-identified. Outcomes and covariates
The following demographic and anthropometric data were collected 1 year before the first hospitalization date for ACS: age, sex, height, weight, and blood pressure. BMI was defined as weight (kg) divided by height in meter squared ( m2) and categorized according to the Asian-specific criteria as [13]: underweight ( 30 days, receiving insulin (ATC code A10A) as an outpatient, or fasting blood glucose level of ≥ 126 mg/dL. The primary outcome was MACE—CV death (ICD10 codes I00–I99), MI (ICD-10 codes I21–I22), and stroke (ICD-10 codes I60–I64). The secondary outcomes were individual components of MACE, hospitalization for heart failure (HHF; ICD-10 code I50), and all-cause death. All-cause and CV death were defined by death status in the NHIS database, which was linked to the National Death Registry
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