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Obesity in patients with non-ST-segment elevation acute coronary syndromes: results from the SYNERGY trial.
Int J Cardiol. 2010 Mar 04; 139(2):123-33.IJ

Abstract

BACKGROUND

Obese patients are at increased risk of acute coronary syndromes (ACS). We evaluated the prevalence of obesity in a large ACS population, as well as the relationship between body mass index (BMI) and the use of cardiac medications and procedures, clinical outcomes, and treatment effects between enoxaparin and unfractionated heparin (UFH).

METHODS

Using the database of the SYNERGY trial, we identified 9978 patients in 12 countries who were randomly assigned to receive enoxaparin or UFH. Patient weight at baseline and 30-day follow-up was recorded. BMI information was available on 9837 patients. BMI was analyzed in clinically meaningful categories (<20, 20-25, 30-35, > or =35 kg/m(2)) and as a continuous variable.

RESULTS

Thirty-two percent of patients were obese (BMI> or =30), with a greater proportion of patients with obesity from North America (36%) compared with other regions. Enoxaparin was dosed as 1 mg/kg regardless of body weight without maximum. The first dose of enoxaparin was underdosed in 15% of patients assigned enoxaparin, and obese patients were more likely to be underdosed than non-obese patients. Obese patients were younger, less often white, had more diabetes, hypertension, hyperlipidemia, family history of coronary artery disease, and congestive heart failure but fewer strokes, less peripheral vascular disease, and less often smoked. After adjustment, increased BMI was not an independent predictor of bleeding outcomes or 30-day death/myocardial infarction (MI), but increased BMI was predictive of lower 1-year mortality in the subgroup of patients with BMI at baseline below approximately 30 kg/m(2). No statistical interaction term was observed between obesity and randomized therapy for the outcomes of death/MI at 30 days and 6 months; death at 30 days, 6 months, and 1 year; and GUSTO or TIMI bleeding.

CONCLUSIONS

Nearly one third of patients in SYNERGY were obese. Despite multiple comorbidities, obese patients had better unadjusted short- and long-term outcomes. After adjustment, higher BMI was not an independent predictor of in-hospital bleeding events or 30-day death/MI, but increased BMI was an independent predictor of 1-year mortality in patients with lower BMI but not in heavier patients. No interaction between the randomized treatment and obesity for efficacy and safety outcomes was observed across the range of BMI in this dataset. Standard dosing of enoxaparin should be used in patients without extreme obesity due to limited outcome data in these patients.

Authors+Show Affiliations

Duke Clinical Research Institute, Durham, NC 27715, USA. mahaf002@mc.duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19012977

Citation

Mahaffey, Kenneth W., et al. "Obesity in Patients With non-ST-segment Elevation Acute Coronary Syndromes: Results From the SYNERGY Trial." International Journal of Cardiology, vol. 139, no. 2, 2010, pp. 123-33.
Mahaffey KW, Tonev ST, Spinler SA, et al. Obesity in patients with non-ST-segment elevation acute coronary syndromes: results from the SYNERGY trial. Int J Cardiol. 2010;139(2):123-33.
Mahaffey, K. W., Tonev, S. T., Spinler, S. A., Levine, G. N., Gallo, R., Ducas, J., Goodman, S. G., Antman, E. M., Becker, R. C., Langer, A., White, H. D., Aylward, P. E., Col, J. J., Ferguson, J. J., & Califf, R. M. (2010). Obesity in patients with non-ST-segment elevation acute coronary syndromes: results from the SYNERGY trial. International Journal of Cardiology, 139(2), 123-33. https://doi.org/10.1016/j.ijcard.2008.10.008
Mahaffey KW, et al. Obesity in Patients With non-ST-segment Elevation Acute Coronary Syndromes: Results From the SYNERGY Trial. Int J Cardiol. 2010 Mar 4;139(2):123-33. PubMed PMID: 19012977.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obesity in patients with non-ST-segment elevation acute coronary syndromes: results from the SYNERGY trial. AU - Mahaffey,Kenneth W, AU - Tonev,Simon T, AU - Spinler,Sarah A, AU - Levine,Glenn N, AU - Gallo,Richard, AU - Ducas,John, AU - Goodman,Shaun G, AU - Antman,Elliott M, AU - Becker,Richard C, AU - Langer,Anatoly, AU - White,Harvey D, AU - Aylward,Philip E, AU - Col,Jacques J, AU - Ferguson,James J, AU - Califf,Robert M, AU - ,, Y1 - 2008/11/14/ PY - 2007/10/24/received PY - 2008/09/22/revised PY - 2008/10/12/accepted PY - 2008/11/18/pubmed PY - 2010/6/9/medline PY - 2008/11/18/entrez SP - 123 EP - 33 JF - International journal of cardiology JO - Int J Cardiol VL - 139 IS - 2 N2 - BACKGROUND: Obese patients are at increased risk of acute coronary syndromes (ACS). We evaluated the prevalence of obesity in a large ACS population, as well as the relationship between body mass index (BMI) and the use of cardiac medications and procedures, clinical outcomes, and treatment effects between enoxaparin and unfractionated heparin (UFH). METHODS: Using the database of the SYNERGY trial, we identified 9978 patients in 12 countries who were randomly assigned to receive enoxaparin or UFH. Patient weight at baseline and 30-day follow-up was recorded. BMI information was available on 9837 patients. BMI was analyzed in clinically meaningful categories (<20, 20-25, 30-35, > or =35 kg/m(2)) and as a continuous variable. RESULTS: Thirty-two percent of patients were obese (BMI> or =30), with a greater proportion of patients with obesity from North America (36%) compared with other regions. Enoxaparin was dosed as 1 mg/kg regardless of body weight without maximum. The first dose of enoxaparin was underdosed in 15% of patients assigned enoxaparin, and obese patients were more likely to be underdosed than non-obese patients. Obese patients were younger, less often white, had more diabetes, hypertension, hyperlipidemia, family history of coronary artery disease, and congestive heart failure but fewer strokes, less peripheral vascular disease, and less often smoked. After adjustment, increased BMI was not an independent predictor of bleeding outcomes or 30-day death/myocardial infarction (MI), but increased BMI was predictive of lower 1-year mortality in the subgroup of patients with BMI at baseline below approximately 30 kg/m(2). No statistical interaction term was observed between obesity and randomized therapy for the outcomes of death/MI at 30 days and 6 months; death at 30 days, 6 months, and 1 year; and GUSTO or TIMI bleeding. CONCLUSIONS: Nearly one third of patients in SYNERGY were obese. Despite multiple comorbidities, obese patients had better unadjusted short- and long-term outcomes. After adjustment, higher BMI was not an independent predictor of in-hospital bleeding events or 30-day death/MI, but increased BMI was an independent predictor of 1-year mortality in patients with lower BMI but not in heavier patients. No interaction between the randomized treatment and obesity for efficacy and safety outcomes was observed across the range of BMI in this dataset. Standard dosing of enoxaparin should be used in patients without extreme obesity due to limited outcome data in these patients. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/19012977/Obesity_in_patients_with_non_ST_segment_elevation_acute_coronary_syndromes:_results_from_the_SYNERGY_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(08)01066-8 DB - PRIME DP - Unbound Medicine ER -