{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T09:08:08Z","timestamp":1771232888382,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,11,15]],"date-time":"2022-11-15T00:00:00Z","timestamp":1668470400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In patients with some cardiovascular disease conditions, slightly elevated body mass index (BMI) is associated with a lower mortality risk (termed \u201cobesity paradox\u201d). It is uncertain, however, if this obesity paradox exists in patients who have had invasive cardiology procedures. We evaluated the association between BMI and mortality in patients who underwent coronary angiography.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We utilised the KARDIO registry, which comprised data on demographics, prevalent diseases, risk factors, coronary angiographies, and interventions on 42,636 patients. BMI was categorised based on WHO cut\u2010offs or transformed using P\u2010splines. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for all\u2010cause mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a median follow\u2010up of 4.9 years, 4688 all\u2010cause deaths occurred. BMI was nonlinearly associated with mortality risk: compared to normal weight category (18.5\u201325\u2009kg\/m<jats:sup>2<\/jats:sup>), the age\u2010adjusted HRs (95% CIs) for all\u2010cause mortality were 1.90 (1.49, 2.43), 0.96 (0.92, 1.01), 1.04 (0.99, 1.09), 1.08 (0.96, 1.20), and 1.45 (1.22, 1.72) for underweight (&lt;18.5\u2009kg\/m<jats:sup>2<\/jats:sup>), preobesity (25 to &lt;30\u2009kg\/m<jats:sup>2<\/jats:sup>), obesity class I (30 to &lt;35\u2009kg\/m<jats:sup>2<\/jats:sup>), obesity class II (35 to &lt;40\u2009kg\/m<jats:sup>2<\/jats:sup>), and obesity class III (&gt;40\u2009kg\/m<jats:sup>2<\/jats:sup>), respectively. The corresponding multivariable adjusted HRs (95% CIs) were 2.00 (1.55, 2.58), 0.92 (0.88, 0.97) 1.01 (0.95, 1.06), 1.10 (0.98, 1.23), and 1.49 (1.26, 1,78), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients undergoing coronary angiography, underweight and obesity class III are associated with increased mortality risk, and the lowest mortality was observed in the preobesity class. It appears the obesity paradox may be present in patients who undergo invasive coronary procedures.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.30463","type":"journal-article","created":{"date-parts":[[2022,11,15]],"date-time":"2022-11-15T18:33:28Z","timestamp":1668537208000},"page":"1242-1251","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Underweight and obesity are related to higher mortality in patients undergoing coronary angiography: The KARDIO invasive cardiology register study"],"prefix":"10.1002","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3738-1586","authenticated-orcid":false,"given":"Jari A.","family":"Laukkanen","sequence":"first","affiliation":[{"name":"School of Medicine Institute of Clinical Medicine, University of Eastern Finland  Kuopio Finland"},{"name":"Central Finland Health Care District, Department of Medicine  Jyv\u00e4skyl\u00e4 Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Setor K.","family":"Kunutsor","sequence":"additional","affiliation":[{"name":"Central Finland Health Care District, Department of Medicine  Jyv\u00e4skyl\u00e4 Finland"},{"name":"Leicester Real World Evidence Unit, Diabetes Research Centre University of Leicester, Leicester General Hospital  Leicester UK"},{"name":"Translational Health Sciences, Bristol Medical School University of Bristol, Learning &amp; Research Building (Level 1), Southmead Hospital  Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jussi","family":"Hernesniemi","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology Tampere University Hospital  Tampere Finland"},{"name":"Faculty of Medicine and Health Technology Tampere University  Tampere Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaakko","family":"Immonen","sequence":"additional","affiliation":[{"name":"Central Finland Health Care District, Department of Medicine  Jyv\u00e4skyl\u00e4 Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markku","family":"Eskola","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology Tampere University Hospital  Tampere Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Zaccardi","sequence":"additional","affiliation":[{"name":"Central Finland Health Care District, Department of Medicine  Jyv\u00e4skyl\u00e4 Finland"},{"name":"Leicester Real World Evidence Unit, Diabetes Research Centre University of Leicester, Leicester General Hospital  Leicester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matti","family":"Niemel\u00e4","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Oulu University Hospital  Oulu Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"M\u00e4kikallio","sequence":"additional","affiliation":[{"name":"Department of Medicine South\u2010Karelia Central Hospital  Lappeenranta Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magnus","family":"Hagn\u00e4s","sequence":"additional","affiliation":[{"name":"Lapland Health Care District, Department of Internal Medicine  Rovaniemi Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jarkko","family":"Piuhola","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Oulu University Hospital  Oulu Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jukka","family":"Juvonen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Kainuu Central Hospital  Kajaani Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jussi","family":"Sia","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokkola Central Hospital  Kokkola Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juha","family":"Rummukainen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Satakunta Central Hospital  Pori Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kari","family":"Kervinen","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine Oulu University Hospital  Oulu Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juha","family":"Karvanen","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Statistics University of Jyvaskyla  Jyv\u00e4skyl\u00e4 Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kjell","family":"Nikus","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology Tampere University Hospital  Tampere Finland"},{"name":"Faculty of Medicine and Health Technology Tampere University  Tampere Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"KARDIO Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,11,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(18)30288-2"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2010.03.018"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/AC.70.4.3096897"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2016.01.008"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2016.11.001"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjqcco\/qcx018"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2017.08.003"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2014.04.020"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-014-9961-9"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.09.030"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs217"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2017.08.009"},{"key":"e_1_2_10_14_1","unstructured":"FrankEHJ.\u00a0Hmisc: Harrell Miscellaneous. R package version 4.5\u20100.2022.\u00a0https:\/\/CRAN.R-project.org\/package=Hmisc"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/9780470316696"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1201\/b11826"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1214\/ss\/1038425655"},{"key":"e_1_2_10_18_1","unstructured":"TherneauT.\u00a0A Package for Survival Analysis in S. version 2.38; 2015.https:\/\/CRAN.R-project.org\/package=survival"},{"key":"e_1_2_10_19_1","volume-title":"A language and environment for statistical computing","author":"R\u00a0Core\u00a0Team.\u00a0","year":"2019"},{"key":"e_1_2_10_20_1","volume-title":"ggplot2: Elegant Graphics for Data Analysis","author":"Hadley W","year":"2016"},{"key":"e_1_2_10_21_1","unstructured":"KassambaraAKM BiecekP.\u00a02019 survminer: Drawing Survival Curves using \u2018ggplot2\u2019. R package version 0.4.6; 2019.\u00a0https:\/\/CRAN.R-project.org\/package=survminer"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2261-14-68"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2010.71"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0802985"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2020.06.010"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.36660\/abc.20200522"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jes179"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn387"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.666941"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht085"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000002313"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.012860"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-303066"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2017.01.043"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.01.011"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2012.01.013"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.08.1037"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2021.09.010"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.14438"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz188"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.30463","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.30463","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.30463","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T17:12:04Z","timestamp":1692551524000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.30463"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,15]]},"references-count":39,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1002\/ccd.30463"],"URL":"https:\/\/doi.org\/10.1002\/ccd.30463","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,15]]},"assertion":[{"value":"2022-07-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}