Underweight, Markers of Cachexia, and Mortality in Acute Myocardial Infarction: A Prospective Cohort Study of Elderly Medicare Beneficiaries
Publication Date
April 19, 2016
Journal
PLOS Medicine
Authors
Emily M. Bucholz, Hannah A Krumholz & Harlan M. Krumholz
Volume
13
Issue
4
Pages
e1001998
DOI
https://dx.plos.org/10.1371/journal.pmed.1001998
Publisher URL
http://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1001998
Web of Science
000375096900009
Scopus
84964594462
Mendeley
http://www.mendeley.com/research/underweight-markers-cachexia-mortality-acute-myocardial-infarction-prospective-cohort-study-elderly-2
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Mendeley | Further Information

{"title"=>"Underweight, Markers of Cachexia, and Mortality in Acute Myocardial Infarction: A Prospective Cohort Study of Elderly Medicare Beneficiaries", "type"=>"journal", "authors"=>[{"first_name"=>"Emily M.", "last_name"=>"Bucholz", "scopus_author_id"=>"36196207600"}, {"first_name"=>"Hannah A.", "last_name"=>"Krumholz", "scopus_author_id"=>"57086027300"}, {"first_name"=>"Harlan M.", "last_name"=>"Krumholz", "scopus_author_id"=>"55152053200"}], "year"=>2016, "source"=>"PLoS Medicine", "identifiers"=>{"sgr"=>"84964594462", "pmid"=>"27093615", "pui"=>"610202052", "issn"=>"15491676", "scopus"=>"2-s2.0-84964594462", "doi"=>"10.1371/journal.pmed.1001998"}, "id"=>"928dc974-a3cd-3793-96d2-173626d28174", "abstract"=>"BACKGROUND: Underweight patients are at higher risk of death after acute myocardial infarction (AMI) than normal weight patients; however, it is unclear whether this relationship is explained by confounding due to cachexia or other factors associated with low body mass index (BMI). This study aimed to answer two questions: (1) does comprehensive risk adjustment for comorbid illness and frailty measures explain the higher mortality after AMI in underweight patients, and (2) is the relationship between underweight and mortality also observed in patients with AMI who are otherwise without significant chronic illness and are presumably free of cachexia?\\n\\nMETHODS AND FINDINGS: We analyzed data from the Cooperative Cardiovascular Project, a cohort-based study of Medicare beneficiaries hospitalized for AMI between January 1994 and February 1996 with 17 y of follow-up and detailed clinical information to compare short- and long-term mortality in underweight and normal weight patients (n = 57,574). We used Cox proportional hazards regression to investigate the association of low BMI with 30-d, 1-y, 5-y, and 17-y mortality after AMI while adjusting for patient comorbidities, frailty measures, and laboratory markers of nutritional status. We also repeated the analyses in a subset of patients without significant comorbidity or frailty. Of the 57,574 patients with AMI included in this cohort, 5,678 (9.8%) were underweight and 51,896 (90.2%) were normal weight at baseline. Underweight patients were older, on average, than normal weight patients and had a higher prevalence of most comorbidities and measures of frailty. Crude mortality was significantly higher for underweight patients than normal weight patients at 30 d (25.2% versus 16.4%, p < 0.001), 1 y (51.3% versus 33.8%, p < 0.001), 5 y (79.2% versus 59.4%, p < 0.001), and 17 y (98.3% versus 94.0%, p < 0.001). After adjustment, underweight patients had a 13% higher risk of 30-d death and a 26% higher risk of 17-y death than normal weight patients (30-d hazard ratio [HR] 1.13, 95% CI 1.07-1.20; 17-y HR 1.26, 95% CI 1.23-1.30). Survival curves for underweight and normal weight patients separated early and remained separate over 17 y, suggesting that underweight patients remained at a significant survival disadvantage over time. Similar findings were observed among the subset of patients without comorbidity at baseline. Underweight patients without comorbidity had a 30-d adjusted mortality similar to that of normal weight patients but a 21% higher risk of death over the long term (30-d HR 1.08, 95% CI 0.93-1.26; 17-y HR 1.21, 95% CI 1.14-1.29). The adverse effects of low BMI were greatest in patients with very low BMIs. The major limitation of this study was the use of surrogate markers of frailty and comorbid conditions to identify patients at highest risk for cachexia rather than clear diagnostic criteria for cachexia.\\n\\nCONCLUSIONS: Underweight BMI is an important risk factor for mortality after AMI, independent of confounding by comorbidities, frailty measures, and laboratory markers of nutritional status. Strategies to promote weight gain in underweight patients after AMI are worthy of testing.", "link"=>"http://www.mendeley.com/research/underweight-markers-cachexia-mortality-acute-myocardial-infarction-prospective-cohort-study-elderly-2", "reader_count"=>18, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>1, "Researcher"=>3, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>1, "Student > Master"=>3, "Other"=>2, "Student > Bachelor"=>5, "Professor"=>2}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>1, "Researcher"=>3, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>1, "Student > Master"=>3, "Other"=>2, "Student > Bachelor"=>5, "Professor"=>2}, "reader_count_by_subject_area"=>{"Nursing and Health Professions"=>2, "Biochemistry, Genetics and Molecular Biology"=>2, "Medicine and Dentistry"=>12, "Agricultural and Biological Sciences"=>1, "Psychology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>12}, "Psychology"=>{"Psychology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>2}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}}, "group_count"=>3}

Scopus | Further Information

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