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Obesity and CHD Association in Type 2 Diabetes Patients

Are obesity and CHD truly associated?…

Researchers from the U.S. and China examined data on 30,434 diabetic patients from the Louisiana State University Hospital-Based Longitudinal Study (10,955 men and 19,479 women). Patients included were 30-95 years of age without a history of CHD or stroke in the Louisiana State University Hospital. Using ICD-9 (code 250), a cohort of diabetic patients was established between January 1999-December 2009. Patients were excluded if they were underweight (BMI < 1805 kg/m2). This study did not obtain informed consent because they collected the data from electronic medical records anonymously.

During a mean follow-up period of 7.3 years, 7,414 subjects developed CHD. The multivariable-adjusted hazard ratios for CHD across levels of BMI at baseline (18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and ≥40 kg/m2) were 1.00, 1.14 (95% CI 1.00–1.29), 1.27 (1.12–1.45), 1.54 (1.34–1.78), and 1.42 (1.23–1.64) (Ptrend < 0.001) in men and 1.00, 0.95 (95% CI 0.85–1.07), 0.95 (0.84–1.06), 1.06 (0.94–1.20), and 1.09 (1.00–1.22) (Ptrend < 0.001) in women, respectively. When the researchers used an updated mean or last visit value of BMI, the positive association between BMI and CHD risk did not change in men. However, the positive association of BMI with CHD changed to a U-shaped association in women when they used the last visit value of BMI.

The authors concluded that there is a significant association between BMI at baseline and during follow-up with the risk of CHD among type 2 diabetic patients. Among women with type 2 diabetes, the study has demonstrated a U-shape association between BMI at the last visit and the risk for CHD.

Practice Pearls:

  • This study identified a significant association of BMI at baseline and during follow-up with the risk of CHD among type 2 diabetic patients.
  • This study was the first study to demonstrate a positive association; therefore, more studies are necessary to confirm these results.
  • In this study, a positive association between BMI with the risk of CHD was higher among women than among men.

Li N, Katzmarzyk PT, Horswell R, et al. BMI and Coronary Heart Disease Risk Among Low-Income and Underinsured Diabetic Patients. Diabetes Care 2014; 37:3204-3212