{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:04:31Z","timestamp":1753877071235,"version":"3.41.2"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T00:00:00Z","timestamp":1695340800000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Cardiovascular R&D Center\u2014UnIC"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>The aim of this sudy was to investigate the presence of an obesity paradox on the long-term mortality of patients undergoing primary isolated coronary artery bypass surgery and to uncover whether any discrepancy found could be attributable to cardiovascular or noncardiovascular causes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Retrospective analysis of 5242 consecutive patients with body mass index (BMI) over 18.5\u2009kg\/m2 undergoing primary isolated coronary artery bypass surgery, performed from 2000 to 2015, in a Portuguese level III Hospital. The primary end point was long-term all-cause mortality. Secondary outcomes were long-term cause-specific mortality (cardiovascular and noncardiovascular). We fitted overall, and cause-specific hazard models, with BMI forced both as a categorical (using World Health Organization predefined cutoffs) and as a continuous variable.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Follow-up was 99.7% complete. The median follow-up time was 12.79\u2009years (interquartile range, 9.51\u201316.61). The cumulative incidence functions failed to uncover any difference in 15-year all-cause (log-rank test, P\u2009=\u20090.400), cardiovascular (Gray's test, P\u2009=\u20090.996) and noncardiovascular mortality (Gray's test, P\u2009=\u20090.305) between BMI categories. Likewise, extensive multivariable-adjusted Cox regression and cause-specific hazards models failed to demonstrate in-between category differences, with BMI forced as a categorical variable. On the other hand, using BMI as a continuous variable, the model identified the optimal BMI as between 25.8 and 30.3\u2009kg\/m2 (nadir around 28.9\u2009kg\/m2), albeit this was dependent on the definition of the reference value.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>In this longitudinal, population-level analysis of patients undergoing isolated primary coronary artery bypass grafting, we could not attest to any protective effect of obesity on long-term survival.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivad161","type":"journal-article","created":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T04:07:45Z","timestamp":1695442065000},"source":"Crossref","is-referenced-by-count":0,"title":["Body mass index effect on long-term survival after coronary artery bypass surgery: a competing risk analysis"],"prefix":"10.1093","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4876-5179","authenticated-orcid":false,"given":"Armando","family":"Abreu","sequence":"first","affiliation":[{"name":"Cardiovascular R&D Center\u2014UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto , Porto, Portugal"},{"name":"Department of Cardiothoracic Surgery, S\u00e3o Jo\u00e3o University Hospital Center , Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8275-5500","authenticated-orcid":false,"given":"Jos\u00e9","family":"M\u00e1ximo","sequence":"additional","affiliation":[{"name":"Cardiovascular R&D Center\u2014UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto , Porto, Portugal"},{"name":"Department of Cardiothoracic Surgery, S\u00e3o Jo\u00e3o University Hospital Center , Porto, Portugal"}]},{"given":"Francisca","family":"Saraiva","sequence":"additional","affiliation":[{"name":"Cardiovascular R&D Center\u2014UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto , Porto, Portugal"}]},{"given":"Adelino","family":"Leite-Moreira","sequence":"additional","affiliation":[{"name":"Cardiovascular R&D Center\u2014UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto , Porto, Portugal"},{"name":"Department of Cardiothoracic Surgery, S\u00e3o Jo\u00e3o University Hospital Center , Porto, Portugal"}]}],"member":"286","published-online":{"date-parts":[[2023,9,22]]},"reference":[{"author":"World Health Organization","key":"2023092805231297000_ivad161-B1"},{"key":"2023092805231297000_ivad161-B2","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1038\/s41574-019-0176-8","article-title":"Obesity: global epidemiology and pathogenesis","volume":"15","author":"Bl\u00fcher","year":"2019","journal-title":"Nat Rev Endocrinol"},{"key":"2023092805231297000_ivad161-B3","doi-asserted-by":"crossref","first-page":"e984","DOI":"10.1161\/CIR.0000000000000973","article-title":"Obesity and cardiovascular disease: a scientific statement from the American Heart Association","volume":"143","author":"Powell-Wiley","year":"2021","journal-title":"Circulation"},{"key":"2023092805231297000_ivad161-B4","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1016\/j.jacc.2008.12.068","article-title":"Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss","volume":"53","author":"Lavie","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2023092805231297000_ivad161-B5","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/S0735-1097(02)01687-X","article-title":"The impact of body mass index on short- and long-term outcomes inpatients undergoing coronary revascularization. Insights from the bypass angioplasty revascularization investigation (BARI)","volume":"39","author":"Gurm","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2023092805231297000_ivad161-B6","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0002-8703(03)00185-6","article-title":"Obesity and the risk of early and late mortality after coronary artery bypass graft surgery","volume":"146","author":"Kim","year":"2003","journal-title":"Am Heart J"},{"key":"2023092805231297000_ivad161-B7","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/S0735-1097(03)00777-0","article-title":"Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery","volume":"42","author":"Reeves","year":"2003","journal-title":"J Am Coll Cardiol"},{"key":"2023092805231297000_ivad161-B8","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.athoracsur.2009.09.050","article-title":"Effect of body mass index on early and late mortality after coronary artery bypass grafting","volume":"89","author":"van Straten","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"2023092805231297000_ivad161-B9","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.athoracsur.2007.03.017","article-title":"Relationship of body mass index with outcomes after coronary artery bypass graft surgery","volume":"84","author":"Wagner","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"2023092805231297000_ivad161-B10","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1016\/j.jtcvs.2013.05.028","article-title":"Obesity paradox in coronary artery bypass grafting: myth or reality?","volume":"147","author":"Benedetto","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023092805231297000_ivad161-B11","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1093\/ejcts\/ezy207","article-title":"Evidence and temporality of the obesity paradox in coronary bypass surgery: an analysis of cause-specific mortality","volume":"54","author":"Schwann","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"issue":"7","key":"2023092805231297000_ivad161-B12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1161\/JAHA.115.002140","article-title":"Body mass index, outcomes, and mortality following cardiac surgery in Ontario, Canada","volume":"4","author":"Johnson","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"2023092805231297000_ivad161-B13","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1177\/2048872616633844","article-title":"Obesity paradox disappears in coronary artery bypass graft patients during 20-year follow-up","volume":"6","author":"H\u00e4llberg","year":"2017","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2023092805231297000_ivad161-B14","doi-asserted-by":"crossref","first-page":"754934","DOI":"10.3389\/fcvm.2021.754934","article-title":"The relationship between body mass index and in-hospital mortality in patients following coronary artery bypass grafting surgery","volume":"8","author":"Elbaz-Greener","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"2023092805231297000_ivad161-B15","doi-asserted-by":"crossref","first-page":"3867735","DOI":"10.1155\/2021\/3867735","article-title":"Obesity paradox of all-cause mortality in 4,133 patients treated with coronary revascularization","volume":"2021","author":"Li","year":"2021","journal-title":"J Interv Cardiol"},{"key":"2023092805231297000_ivad161-B16","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.jjcc.2015.09.015","article-title":"Overweight, but not obesity, paradox on mortality following coronary artery bypass grafting","volume":"68","author":"Takagi","year":"2016","journal-title":"J Cardiol"},{"key":"2023092805231297000_ivad161-B17","doi-asserted-by":"crossref","first-page":"e0274129","DOI":"10.1371\/journal.pone.0274129","article-title":"The association between different body mass index levels and midterm surgical revascularization outcomes","volume":"17","author":"Masoudkabir","year":"2022","journal-title":"PLoS One"},{"key":"2023092805231297000_ivad161-B18","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1161\/CIRCULATIONAHA.115.017719","article-title":"Introduction to the analysis of survival data in the presence of competing risks","volume":"133","author":"Austin","year":"2016","journal-title":"Circulation"},{"key":"2023092805231297000_ivad161-B19","doi-asserted-by":"crossref","first-page":"648","DOI":"10.21105\/joss.00648","article-title":"comorbidity: an R package for computing comorbidity scores","volume":"3","author":"Gasparini","year":"2018","journal-title":"JOSS"},{"key":"2023092805231297000_ivad161-B20","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"author":"Therneau","key":"2023092805231297000_ivad161-B21"},{"volume-title":"R: A Language and Environment for Statistical Computing","year":"2022","author":"R Core Team","key":"2023092805231297000_ivad161-B22"},{"year":"2022","author":"Therneau","key":"2023092805231297000_ivad161-B23"},{"author":"Wickham","key":"2023092805231297000_ivad161-B24"},{"key":"2023092805231297000_ivad161-B25","doi-asserted-by":"crossref","first-page":"570","DOI":"10.32614\/RJ-2021-053","article-title":"Reproducible Summary Tables with the gtsummary Package","volume":"13","author":"Sjoberg","year":"2021","journal-title":"The R Journal"},{"year":"2022","author":"Gray","key":"2023092805231297000_ivad161-B26"},{"year":"2022","author":"Sjoberg","key":"2023092805231297000_ivad161-B27"},{"year":"2021","author":"Kassambara","key":"2023092805231297000_ivad161-B28"},{"key":"2023092805231297000_ivad161-B29","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1093\/ejcts\/ezx138","article-title":"Categorizing body mass index biases assessment of the association with post-coronary artery bypass graft mortality","volume":"52","author":"Filardo","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2023092805231297000_ivad161-B30","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1093\/oxfordjournals.aje.a008733","article-title":"How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups?","volume":"143","author":"Gallagher","year":"1996","journal-title":"Am J Epidemiol"},{"key":"2023092805231297000_ivad161-B31","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1038\/ijo.2008.11","article-title":"Accuracy of body mass index in diagnosing obesity in the adult general population","volume":"32","author":"Romero-Corral","year":"2008","journal-title":"Int J Obes (Lond)"},{"key":"2023092805231297000_ivad161-B32","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1210\/jc.2009-1584","article-title":"The predictive value of different measures of obesity for incident cardiovascular events and mortality","volume":"95","author":"Schneider","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"2023092805231297000_ivad161-B33","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1001\/archinternmed.2010.201","article-title":"Waist circumference and all-cause mortality in a large US cohort","volume":"170","author":"Jacobs","year":"2010","journal-title":"Arch Intern Med"},{"key":"2023092805231297000_ivad161-B34","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1038\/sj.ejcn.1602656","article-title":"Preferred clinical measures of central obesity for predicting mortality","volume":"61","author":"Welborn","year":"2007","journal-title":"Eur J Clin Nutr"},{"key":"2023092805231297000_ivad161-B35","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.pcad.2013.08.003","article-title":"The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox","volume":"56","author":"De Schutter","year":"2014","journal-title":"Prog Cardiovasc Dis"},{"key":"2023092805231297000_ivad161-B36","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1097\/01.smj.0000224337.77074.57","article-title":"Death certificates are not reliable: revivification of the autopsy","volume":"99","author":"Ravakhah","year":"2006","journal-title":"South Med J"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivad161\/51728139\/ivad161.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/37\/3\/ivad161\/51784311\/ivad161.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/37\/3\/ivad161\/51784311\/ivad161.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T05:23:33Z","timestamp":1695878613000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivad161\/7280701"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,1]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,9,2]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivad161","relation":{},"ISSN":["2753-670X"],"issn-type":[{"type":"electronic","value":"2753-670X"}],"subject":[],"published-other":{"date-parts":[[2023,9,1]]},"published":{"date-parts":[[2023,9,1]]},"article-number":"ivad161"}}