Latest findings from the Physicians’ Health Study

Elevated BMI May Not Increase Risk of Death Among Men with Heart Attack or Stroke

Boston — BMI, or body mass index, is considered an indicator of both mortality and heart attack risk among middle-aged and older men free of major diseases. However, the impact of BMI on mortality in men who have already had a heart attack or stroke has not been clearly established. In the largest analysis to date, researchers from Brigham and Women’s Hospital (BWH) report that men with an elevated BMI – 28.0 kg/m 2 or greater – may not have an increased risk of death as compared to men with a lower BMI. These findings are published in the November 22, 2004 issue of the Archives of Internal Medicine .

“This study does not eliminate a small amount of risk for being overweight or obese,” said author Howard D. Sesso, ScD, MPH, of BWH. “However, it does tell physicians that BMI may not have a prominent role in predicting the future risk of death among men who may have already experienced the cardiovascular complications of obesity by having a heart attack or stroke.”

In this study, researchers examined 5,010 middle-aged and older men from the Physicians’ Health Study with approximately five years of follow-up data. Those analyzed included men who had a self-reported history of heart attack or stroke, while excluding those with cancer. Four BMI categories were used that ranged from less than 22.0 kg/m 2 (normal weight men) to 28.0 kg/m 2 or greater (which includes both overweight and obese men). Researchers found that men who already had a heart attack or stroke with a BMI of 28 kg/m 2 or greater did not have a significantly greater risk of overall death or death from cardiovascular disease.

According to Sesso, “Although it is a matter of debate as to why BMI may be less important in the secondary prevention of cardiovascular disease, we know that in primary prevention having a progressively higher BMI results in large increases in the risk of cardiovascular disease, diabetes mellitus and other disorders. For those men who have already suffered from a heart attack or stroke, researchers must identify stronger risk factors than body mass index for mortality to ensure that an optimal secondary prevention strategy is used.”

BWH is a 735-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners Healthcare System, an integrated health care delivery network. Internationally recognized as a leading academic health care institution, BWH is committed to excellence in patient care, medical research and the training and education of health care professionals. The hospital's preeminence in all aspects of clinical care is coupled with its strength in medical research. A leading recipient of research grants from the National Institutes of Health, BWH conducts internationally acclaimed clinical, basic and epidemiological studies.

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