{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:30:30Z","timestamp":1787581830301,"version":"build-2736575974"},"reference-count":34,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The \u2018obesity paradox\u2019 suggests lower cardiovascular risk at higher body mass index (BMI) after myocardial infarction (MI), but whether it reflects true protection or methodological bias is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>From the nationwide SWEDEHEART registry, patients hospitalized with MI from 2010 to 2021 were included. BMI at admission was modelled both as a continuous variable using restricted cubic splines and categorized into six groups, with 20 to &amp;lt;25\u2005kg\/m2 as reference. The primary outcome was major adverse cardiovascular events (MACE), a composite of recurrent MI, stroke, heart failure hospitalization, or cardiovascular death. Cox regression models estimated the BMI associated with lowest risk and HRs for categorical BMI groups. Adjustments included sociodemographic factors, smoking, and comorbidities not attributed to obesity. Mediation analyses assessed the roles of diabetes, hypertension, and prior cardiovascular disease. In 173 617 patients, the mean age was 71.0 years, 66.7% were men, and mean BMI was 27.1\u2005kg\/m2. During a median follow-up of 3.3 years, 36.5% experienced MACE. BMI had a U-shaped association with MACE, with the lowest risk at BMI 25.1\u2005kg\/m2. The adjusted HR (95% CI) for MACE was 0.99 (0.97\u20131.01) for overweight and 1.17 (1.14\u20131.20) for obesity class I, increasing across higher obesity classes. Excess risk was largely mediated by diabetes, hypertension, and prior cardiovascular disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Obesity was associated with increased risk of MACE, partly mediated by obesity-related risk factors. The findings suggest that previously reported \u2018obesity paradoxes\u2019 may reflect differences in confounder adjustment, handling of mediators, patient populations, and survivor bias.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag410","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:40:14Z","timestamp":1785843614000},"source":"Crossref","is-referenced-by-count":0,"title":["Body mass index and major cardiovascular events after myocardial infarction: a nationwide registry study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6038-5131","authenticated-orcid":false,"given":"Peder","family":"af Geijerstam","sequence":"first","affiliation":[{"name":"Department of Health, Medicine, and Caring Sciences, Link\u00f6ping University , Link\u00f6ping SE-581 83 ,","place":["Sweden"]},{"name":"Primary Healthcare Center Cityh\u00e4lsan Centrum, Region \u00d6sterg\u00f6tland , Norrk\u00f6ping SE-601 82 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