Body mass index is inversely associated with mortality in patients with peripheral vascular disease Jonathan Golledge a, b, * , Oliver Cronin a, b , Vikram Iyer a, b , Barbara Bradshaw a, b , Joseph V. Moxon a, b , Maggie A. Cunningham a, b a Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville 4811, Australia b Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville 4811, Australia article info Article history: Received 27 January 2013 Received in revised form 27 March 2013 Accepted 16 April 2013 Available online 16 May 2013 Keywords: Peripheral vascular disease Obesity Mortality Underweight abstract Background: Current guidelines contain no advice on how to manage obesity and underweight in patients with peripheral vascular disease (PVD). Objectives: The aim of this study was to assess the association of underweight, overweight and obesity with mortality in patients with PVD. Patients and Methods: We recruited 1472 patients with a broad range of presentations of PVD. Under- weight, overweight and obesity were defined by body mass index (BMI) and associated with mortality using Kaplan Meier and Cox proportional hazard analyses. Results: Survival at 3 years was 37.5, 78.1, 86.8 and 87.0% for patients that were underweight, normal weight, overweight and obese at recruitment, respectively, p < 0.001. Patients that were underweight had approximately twice the risk of dying (RR 2.15, 95% CI 1.31e3.55, p ¼ 0.003), while patients that were overweight (RR 0.67, 95% CI 0.49e0.91, p ¼ 0.011) or obese (RR 0.59, 95% CI 0.41e0.85, p ¼ 0.005) had approximately half the risk of dying, after adjustment for other risk factors and using normal weight subjects as the reference group. 823 patients had waist circumference measured at recruitment. Patients with waist circumference in the top quartile had half the risk of dying (RR 0.50, 95% CI 0.26e0.98, p ¼ 0.045). In 267 patients we assessed the relationship between BMI and abdominal fat volumes using computed tomography. BMI was highly correlated with both intra-abdominal and subcutaneous fat volumes. Conclusions: Obesity whether assessed by BMI or central fat deposition is associated with reduced risk of dying in patients with established PVD. Underweight is highly predictive of early mortality in patients with PVD. Ó 2013 Elsevier Ireland Ltd. All rights reserved. Obesity is an important risk factor for cardiovascular events and mortality in the general population [1e3]. Current guidelines recommend weight loss in patients who are obese or overweight with coronary heart disease (CHD) [4,5]. In contrast obesity has been associated with improved outcomes in patients with a range of established chronic diseases [6e16]. Peripheral vascular diseases (PVD) are a group of conditions affecting the vessels outside the heart [17e20]. In general PVD has received less attention than CHD, with a number of studies sug- gesting that risk factors in patients with PVD are frequently managed less intensively than those in CHD patients, despite equal or worse prognosis [21e23]. Current guidelines for treating PVD scarcely mention obesity, weight management and nutrition, thus it is not clear how these should be addressed in this patient group [17e20]. The prognostic importance of anthropometric measures in predicting survival in patients with PVD is controversial [24e44]. Large waist circumference, as part of the metabolic syndrome, has been associated with increased incidence of cardiovascular events in some studies [24e29]. While other studies have associated overweight and obesity with reduced mortality [30e36], or found no association between body mass index (BMI) and survival [37e 44]. Given the inconsistency in previous reports regarding the as- sociation of anthropometric measures with outcome in patients with PVD the current study was designed to examine the associa- tion of BMI with survival in a diverse cohort of PVD patients. The primary aim of this study was to assess the association of under- weight, overweight and obesity with survival in PVD patients. Secondary aims were to assess the association of waist circumfer- ence with survival and to examine the relationship between BMI and central fat deposition. * Corresponding author. Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville 4811, Australia. Tel.: þ61 7 4796 1417; fax: þ61 7 4796 1401. E-mail address: jonathan.golledge@jcu.edu.au (J. Golledge). Contents lists available at SciVerse ScienceDirect Atherosclerosis journal homepage: www.elsevier.com/locate/atherosclerosis 0021-9150/$ e see front matter Ó 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.atherosclerosis.2013.04.030 Atherosclerosis 229 (2013) 549e555