{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:38:19Z","timestamp":1787017099912,"version":"build-2736575974"},"reference-count":26,"publisher":"BMJ","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"accepted":{"date-parts":[[2012,12,10]]},"published-print":{"date-parts":[[2013,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Obesity is paradoxically associated with enhanced survival in patients with established cardiovascular disease. We explored this paradox further by examining the influence of obesity on survival in patients with verified atherosclerotic heart disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and patients<\/jats:title>\n                    <jats:p>This retrospective registry based cohort study included all patients from the Western Denmark Heart Registry with coronary atherosclerosis confirmed by coronary angiography from January 2000 to December 2010. Patients were divided into eight groups according to body mass index (BMI) based on WHO BMI classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study included 37\u2005573 patients (70.7% men) with a mean age of (66.3\u00b111.1) years. During the 11\u2005years of follow-up, 5866 (15.6%) patients died. Multivariable analysis confirmed that the risk of death was the lowest among the preobese patients (27.5\u2264BMI&lt;30\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) with adjusted HR of 0.82 (95% CI 0.71 to 0.95; p=0.008) and increased with both low (BMI&lt;18.50\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) and very high (BMI\u226540\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) BMI, HR 2.04 (95% CI 1.63 to 2.57; p&lt;0.001) and HR 1.35 (95% CI 1.05 to 1.72; p&lt;0.01), respectively. Also the normal weight class I (18.5\u2264BMI&lt;23\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) had a significant risk of mortality HR 1.28 (95% CI 1.13 to 1.45; p&lt;0.001). Obese classes I and II did not differ from the reference group (23\u2264BMI&lt;25\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overweight atherosclerotic heart disease patients have improved survival compared with normal weight patients. Underweight and severely obese patients have increased mortality. Our results lean more towards an overweight paradox than an obesity paradox.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/heartjnl-2012-303066","type":"journal-article","created":{"date-parts":[[2013,1,18]],"date-time":"2013-01-18T23:52:11Z","timestamp":1358553131000},"page":"655-660","source":"Crossref","is-referenced-by-count":57,"title":["Moderate overweight is beneficial and severe obesity detrimental for patients with documented atherosclerotic heart disease"],"prefix":"10.1136","volume":"99","author":[{"given":"Aziza","family":"Azimi","sequence":"first","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mette Gitz","family":"Charlot","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Torp-Pedersen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar H","family":"Gislason","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisette Okkels","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, University of southern Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Thayssen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, University of southern Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Ravkilde","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital Aalborg, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Henrik","family":"Tilsted","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital Aalborg, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens Flensted","family":"Lassen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leif","family":"Thuesen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2013,1,18]]},"reference":[{"key":"2025101712480567000_99.9.655.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.12.068"},{"key":"2025101712480567000_99.9.655.2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-300231"},{"key":"2025101712480567000_99.9.655.3","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.624957"},{"key":"2025101712480567000_99.9.655.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2010.03.018"},{"key":"2025101712480567000_99.9.655.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs092"},{"key":"2025101712480567000_99.9.655.6","doi-asserted-by":"publisher","DOI":"10.1080\/02640414.2011.553965"},{"key":"2025101712480567000_99.9.655.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01802-2"},{"key":"2025101712480567000_99.9.655.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2004.04.016"},{"key":"2025101712480567000_99.9.655.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2009.02.026"},{"key":"2025101712480567000_99.9.655.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2009.11.026"},{"key":"2025101712480567000_99.9.655.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69251-9"},{"key":"2025101712480567000_99.9.655.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.06.002"},{"key":"2025101712480567000_99.9.655.13","first-page":"263","article-title":"The Danish National Hospital Register. 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