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The influence of optimal medical treatment on the ‘obesity paradox’, body mass index and long-term mortality in patients treated with percutaneous coronary intervention: a prospective cohort study
  1. Lisanne Schenkeveld1,
  2. Michael Magro1,
  3. Rohit M Oemrawsingh1,2,
  4. Mattie Lenzen1,
  5. Peter de Jaegere1,
  6. Robert-Jan van Geuns1,
  7. Patrick W Serruys1,
  8. Ron T van Domburg1
  1. 1Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
  2. 2Interuniversity Cardiology Institute Netherlands, Utrecht, the Netherlands
  1. Correspondence to Dr Ron T van Domburg; r.vandomburg{at}


Objective To assess whether the obesity paradox persists in the long term and to study the effect of optimal medical treatment on this phenomenon.

Design A retrospective cohort study.

Setting A tertiary care centre in Rotterdam.

Participants From January 2000 to December 2005, 6332 patients undergoing percutaneous coronary intervention for coronary artery disease were categorised into underweight (body mass index (BMI)<18.5), normal (18.5–24.9), overweight (25–29.9) and obese (>30).

Primary outcome measure Mortality.

Secondary outcome measures Cardiac death and non-fatal myocardial infarction.

Results Optimal medical treatment was more common in obese patients as compared with normal weight patients (85% vs 76%; p<0.001). At a mean of 6.1 years, overweight and obese patients had a lower risk of all-cause mortality (HR: 0.75, 95% CI 0.66 to 0.86 and HR: 0.72, 95% CI 0.60 to 0.87, respectively). After adjusting for OMT in the multivariate analysis, BMI did not remain an independent predictor of long-term mortality (HR: 0.90, 95% CI 0.72 to 1.12 and HR: 1.07, 95% CI: 0.80 to 1.43, respectively).

Conclusion BMI is inversely related to long-term mortality in patients treated with percutaneous coronary intervention. Patients with a normal BMI are on suboptimal medical treatment when compared with those with a high BMI. A more optimal medical treatment in the obese group may explain the observed improved outcome in these patients.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Schenkeveld L, Magro M, Oemrawsingh RM, et al. The influence of optimal medical treatment on the ‘obesity paradox’, body mass index and long-term mortality in patients treated with percutaneous coronary intervention: a prospective cohort study. BMJ Open 2012;2:e000535. doi:10.1136/bmjopen-2011-000535

  • Contributors LS, MM, RMO, ML, PdJ, R-JvG, PWS and RTvD took part in the interpretation of findings and in drafting the manuscript. LS did the statistical analyses. LS, MM, PdJ, R-JvG, PWS and RTvD contributed to the data collection. LS, MM and RTvD took main responsibility for conception and design and for writing of the manuscript. PWS was the primary investigator of the trial. All authors made an final approval of the version to be published.

  • Funding This research received no specific grant from any funding agency in public, commercial or not-for-profit sectors.

  • Competing interests None.

  • Ethics approval The study was performed in line with ethical guidelines in accordance with the Declaration of Helsinki. Data are presented in aggregate and no personal health information is disclosed.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Further information and details on the prospective percutaneous coronary intervention registry data from which this study is derived is available at request from the Erasmus University Medical Centre, Rotterdam, the Netherlands.

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