{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:33:21Z","timestamp":1770899601669,"version":"3.50.1"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Obesity is a growing epidemic that has been linked to the development of cardiovascular disease (CVD). Guideline-directed medications for secondary prevention and risk factor control are recommended for patients with all forms of CVD. The association of body mass index (BMI) with use of medications for secondary prevention and risk factor control in patients with CVD are poorly understood.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>\n              We identified 1\u2009122\u2009567 patients with CVD receiving care in 130 Veterans Affairs facilities from October 1, 2013, to September 30, 2014. Five groups were stratified by BMI\u2014underweight (BMI, &lt;18.5 kg\/m\n              <jats:sup>2<\/jats:sup>\n              ), normal (BMI, 18.5\u201324.9 kg\/m\n              <jats:sup>2<\/jats:sup>\n              ), overweight (BMI, 25\u201329.9 kg\/m\n              <jats:sup>2<\/jats:sup>\n              ), obese (BMI, 30\u201339.9 kg\/m\n              <jats:sup>2<\/jats:sup>\n              ), and extremely obese (BMI, \u226540 kg\/m\n              <jats:sup>2<\/jats:sup>\n              ). A composite of 4 measures\u2014blood pressure &lt;140\/90 mm\u2009Hg, hemoglobin A1c \u22649% in diabetic patients, statin use, and antiplatelet use\u2014termed optimal medial therapy (OMT) was compared among groups. Multivariable logistic regression was performed with normal BMI as the referent category. Underweight patients comprised 12\u2009623 (1.1%), normal BMI 230\u2009471 (20.5%), overweight 413\u2009590 (36.8%), obese 404\u2009105 (36%), and extremely obese 61\u2009778 (5.5%) of the cohort. Only 43.7% of the entire cohort received OMT, and this was the highest in the overweight group. Adjusted odds ratios for receiving OMT were 0.81 (95% CI, 0.77\u20130.85), 1.11 (95% CI, 1.10\u20131.13), 1.08 (95% CI, 1.06\u20131.09), and 0.87 (95% CI, 0.85\u20130.89), for patients who were underweight, overweight, obese, and extremely obese, respectively, compared with normal BMI.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>OMT was low in the entire cohort. There is an inverse U-shaped relationship between OMT and BMI with patients who are underweight and extremely obese less likely to receive OMT compared with patients with normal BMI.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.118.004817","type":"journal-article","created":{"date-parts":[[2019,1,14]],"date-time":"2019-01-14T10:01:27Z","timestamp":1547460087000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Association of Body Mass Index With Risk Factor Optimization and Guideline-Directed Medical Therapy in US Veterans With Cardiovascular Disease"],"prefix":"10.1161","volume":"12","author":[{"given":"Ravi S.","family":"Hira","sequence":"first","affiliation":[{"name":"University of Washington, Seattle (R.S.H., A.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akash","family":"Kataruka","sequence":"additional","affiliation":[{"name":"University of Washington, Seattle (R.S.H., A.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia M.","family":"Akeroyd","sequence":"additional","affiliation":[{"name":"Health Policy, Quality and Informatics Program, Michael E. DeBakey Veteran Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX (J.M.A., L.A.P., S.S.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Ramsey","sequence":"additional","affiliation":[{"name":"Section of Health Services Research, Department of Medicine (D.J.R., L.A.P., S.S.V.), Baylor College of Medicine, Houston, TX."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yashashwi","family":"Pokharel","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Research, Department of Medicine, Saint Luke\u2019s Mid America Heart Institute, University of Missouri\u2014Kansas City (Y.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitinder S.","family":"Gurm","sequence":"additional","affiliation":[{"name":"University of Michigan, Ann Arbor (H.S.G.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khurram","family":"Nasir","sequence":"additional","affiliation":[{"name":"Baptist Health South Florida, Miami (K.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"Deswal","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey VA Medical Center, Houston, TX (A.D., H.J., L.A.P., S.S.V.)."},{"name":"Baylor College of Medicine, Houston, TX (A.D., H.J., M.A., C.M.B., L.A.P., S.S.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hani","family":"Jneid","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey VA Medical Center, Houston, TX (A.D., H.J., L.A.P., S.S.V.)."},{"name":"Baylor College of Medicine, Houston, TX (A.D., H.J., M.A., C.M.B., L.A.P., S.S.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahboob","family":"Alam","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Houston, TX (A.D., H.J., M.A., C.M.B., L.A.P., S.S.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christie M.","family":"Ballantyne","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Research, Department of Medicine (C.M.B.), Baylor College of Medicine, Houston, TX."},{"name":"Baylor College of Medicine, Houston, TX (A.D., H.J., M.A., C.M.B., L.A.P., S.S.V.)."},{"name":"Center for Cardiovascular Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura A.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Health Policy, Quality and Informatics Program, Michael E. 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