Impact of neurohormonal blockade on association between body mass index and mortality.

Research output: Contribution to journalArticle


The prognostic impact of body mass index ( BMI) in patients following acute myocardial infarction ( AMI) may be altered by neurohormonal blockade. Methods: The impact of neurohormonal blockade on the association between BMI and mortality was examined in 5548 patients following AMI ( CONSENSUS II), 50% receiving enalapril and 7% beta- blockade, and in 4367 patients with coronary artery disease ( CAD) ( 4S), 79% with prior AMI, 12% receiving ACEi and 67% beta- blockade. Median follow- up was 0.4 and 5.2 years, respectively. Patients were categorized into 4 BMI groups: Underweight, b22.00; normal- weight, 22.00 - 24.99; overweight, 25.00 - 29.99; obese, = 30.00 kg/ m(2). Multivariable analysis adjusted for demographics, patient history, physical examination, biochemistry and medication. Results: CONSENSUS II: Overall, adjusted mortality ( n= 301) risk was similar across BMI groups. Comparing overweight with normalweight patients, the hazard ratios ( HRs) for mortality differed significantly ( P= 0.028) between patients randomized to placebo ( HR 1.41) and enalapril ( HR 0.75). 4S: Overall, adjusted mortality ( n= 421) risk was similar for normal- weight, overweight and obese patients. In a time- dependent analysis for drug use, comparing obese with normal- weight patients, the HRs for mortality differed significantly ( P= 0.047) between patients without ( HR 1.86) and those with ( HR 0.97) neurohormonal blockade. Conclusion: In patients after AMI or with CAD, high BMI was associated with increased mortality risk among patients not receiving neurohormonal blockade, but with decreased or neutral mortality risk among those receiving neurohormonal blockade. Tests for interaction indicate that neurohormonal blockade may attenuate the relationship between high BMI and increased mortality risk. Neurohormonal blockade may thus partly explain the so- called obesity paradox. (C) 2006 Elsevier Ireland Ltd. All rights reserved.


  • Linn Kennedy
  • Stefan D Anker
  • John Kjekshus
  • Tom J Cook
  • Ronnie Willenheimer
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems


  • acute myocardial infarction, body mass index, neurohormonal blockade, mortality, coronary artery disease
Original languageEnglish
Pages (from-to)33-40
JournalInternational Journal of Cardiology
Publication statusPublished - 2007
Publication categoryResearch

Bibliographic note

The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Emergency medicine/Medicine/Surgery (013240200), Cardiology Research Group (013242120)