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Association between obesity and health-related quality of life in patients with coronary artery disease

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Abstract

Background and Objective:

In patients with coronary artery disease (CAD), obesity is paradoxically associated with better survival (the ‘obesity paradox’). Our objective was to determine whether this counterintuitive relationship extends to health-related quality of life (HRQOL) outcomes.

Design:

Cross-sectional observational study.

Subjects:

All adults undergoing coronary angiography residing in Alberta, Canada between January 2003 and March 2006 in the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry.

Methods:

Patients completed self-reported questionnaires 1 year after their index cardiac catheterization, including the Seattle Angina Questionnaire (SAQ) and the EuroQol 5D (EQ-5D Index). Patients were grouped into six body mass index (BMI) categories (underweight, normal, overweight, mild obesity, moderate obesity and severe obesity). An analysis of covariance was used to create risk-adjusted scores.

Results:

A total of 5362 patients were included in the analysis. Obese patients were younger than normal and overweight participants, and had a higher prevalence of depression and cardiovascular risk factors. In the adjusted models, SAQ physical function scores and the EQ Index (representing overall QOL) were significantly reduced in patients with mild, moderate and severe obesity compared with patients with a normal BMI. Patients with severe obesity had both statistically and clinically significant reductions in HRQOL scores. Depressive symptoms accounted for a large proportion in variability of all HRQOL scores.

Conclusions:

BMI is inversely associated with physical function and overall HRQOL in CAD patients, especially in patients with severe obesity. High body weight is a modifiable risk factor; however, given the apparent obesity paradox in patients with CAD, it is critical that future studies be conducted to fully clarify the relationships between HRQOL and body composition (body fat and lean mass), nutritional state and survival outcomes.

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Acknowledgements

We gratefully acknowledge the cardiac personnel for their diligence in data collection and entry: Foothills Medical Center, Royal Alexandra Hospital and the University of Alberta Hospital. AO is supported by the Heart and Stroke Foundation of Canada Doctoral Research Award and the Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond (GENESIS) scholarship; CN is supported by the Alberta Heritage Foundation for Medical Research (AHFMR) and the Canadian Institutes of Health Research (CIHR); KK is supported by a grant from the National Institute of Diabetes, Digestive and Kidney Disease from the National Institute of Health (NIH) and by a grant-in-aid from the American Heart Association; AS is supported by the CIHR and the Heart and Stroke Foundation of Canada; JE is supported by the CIHR and AHFMR; FM is supported by the AHFMR and the Aventis/Merck Frosst Chair in Patient Health Management. APPROACH was initially funded with a grant from the W. Garfield Weston Foundation. The ongoing operation of this project has been made possible by contributions from the Provincial Wide Services Committee of Alberta Health and Wellness and the following industry sponsors: Merck Frosst Canada Inc., Roche Canada, Eli Lilly Canada Inc., Bristol-Myers Squibb, Philips Medical Systems Canada, Searle Pharmaceuticals, Guidant Corporation, Boston Scientific Ltd and Cordis. We appreciate support from the Calgary Health Region, Capital Health Authority, Libin Cardiovascular Institute and Mazankowski Heart Institute.

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Authors and Affiliations

  1. Department of Clinical Epidemiology, School of Public Health, University of Alberta, Edmonton, Alberta, Canada

    A Oreopoulos & C M Norris

  2. Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada

    R Padwal & F A McAlister

  3. Mazankowski Heart Institute, Edmonton, Alberta, Canada

    R Padwal, F A McAlister & J Ezekowitz

  4. Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada

    J Ezekowitz

  5. Division of Endocrinology, University of Alberta, Edmonton, Alberta, Canada

    A M Sharma

  6. Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, CA, USA

    K Kalantar-Zadeh

  7. Division of Cardiology, David Geffen School of Medicine at UCLA, Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, CA, USA

    G C Fonarow

  8. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada

    C M Norris

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  1. A Oreopoulos
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  2. R Padwal
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  4. J Ezekowitz
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  6. K Kalantar-Zadeh
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  8. C M Norris
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Correspondence to R Padwal.

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Oreopoulos, A., Padwal, R., McAlister, F. et al. Association between obesity and health-related quality of life in patients with coronary artery disease. Int J Obes 34, 1434–1441 (2010). https://doi.org/10.1038/ijo.2010.73

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