The impact of body mass index (BMI) on cardiovascular outcomes in patients receiving
intensive low-density lipoprotein cholesterol (LDL-C) lowering therapy is uncertain.
We performed meta-analysis of 29 randomized controlled trials using PubMed, Embase,
and CENTRAL through April 2019. Therapies were grouped as more intensive LDL-C lowering
therapy (statins, ezetimibe + statin or PCSK9 inhibitors) and less intensive LDL-C
lowering therapy (less potent active control or placebo). Random effects meta-regressions
and meta-analyses were performed to evaluate association of BMI with cardiovascular
endpoints. In 265,766 patients, for every 1 kg/m2 increase in BMI, more intensive therapy compared with less intensive therapy was
associated with hazard ratio (HR) of 1.07 for cardiovascular mortality (95% confidence
interval 1.02 to 1.13); HR of 1.03 for all-cause mortality (0.99 to 1.06) HR of 1.06
for myocardial infarction (1.02 to 1.09), HR of 1.08 (1.03 to 1.12) for revascularization
and HR of 1.04 for MACE (1.01 to 1.07). Meta-analysis showed that patients with BMI
<25 kg/m2 had the highest risk reduction in mortality and cardiovascular outcomes compared
with patients with BMI ≥30 kg/m2 (p-interaction ≤0.05). In conclusion, patients with normal BMI treated with intensive LDL-C lowering regimens may derive
a larger clinical benefit compared with patients with larger BMI. The results could
be due to the higher mortality rate of obese patients that may artificially lower
the efficacy of therapy, or due to a true therapeutic limitation in these patients.
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Article info
Publication history
Published online: December 09, 2019
Received in revised form:
November 29,
2019
Received:
October 30,
2019
Footnotes
Author contribution: Safi U. Khan: Conceptualization, Methodology, Software, Writing- Original draft preparation; Muhammad U. Khan, Shahul Valavoor, Muhammad Zia Khan and Michalina Kołodziejczak: Data curation, Software; Haris Riaz, Paolo Raggi Muhammad Shahzeb Khan, Troy Krupica, Mohamed Alkhouli; Eliano P. Navarese: Writing- Reviewing and Editing.
Identification
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© 2019 Elsevier Inc. All rights reserved.
