{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T14:26:25Z","timestamp":1782311185083,"version":"3.54.5"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,4,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The aim of this study was to determine the influence of various antidiabetic therapies on the relationship between body mass index and all\u2010cause mortality in patients with diabetes mellitus and acute coronary syndrome.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This was a prospective, observational study comprising 1193 patients diagnosed with type 2 diabetes mellitus and acute coronary syndrome. The patients were stratified into 4 body mass index categories, and their mortality rates were compared using time\u2010dependent Cox regression analysis using normal weight (body mass index, 18.5\u201323.9) as the reference. Subsequently, the influence of antidiabetic therapies on the association between\n              <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>\n              and mortality were analyzed. Seventy\u2010four patients (6.2%) died over 2\u00a0years of follow\u2010up. The mortality rate was lowest in the class I obese group (3.35%) and highest in the normal\u2010weight group (9.67%). After adjusting for covariates, class I obesity paradoxically remained significantly protective against mortality compared with normal weight (hazard ratio, 0.141;\n              <jats:italic>P<\/jats:italic>\n              =0.049); interaction term analysis showed that insulin therapy influenced this \u201cobesity paradox\u201d (\n              <jats:italic>P<\/jats:italic>\n              =0.045). When the patients were stratified by insulin use, the protective effect of obesity disappeared in the insulin\u2010treated patients but persisted in the non\u2013insulin\u2010treated patients.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In patients with type 2 diabetes mellitus and acute coronary syndrome, the relationship between body mass index and mortality rate is U\u2010shaped, with class I obesity representing the nadir and normal weight the peak. The protective effect of obesity disappeared in patients treated with insulin.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.011215","type":"journal-article","created":{"date-parts":[[2019,3,23]],"date-time":"2019-03-23T09:00:37Z","timestamp":1553331637000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Relationship Between Body Mass Index, Antidiabetic Agents, and Midterm Mortality in Patients With Both Type 2 Diabetes Mellitus and Acute Coronary Syndrome"],"prefix":"10.1161","volume":"8","author":[{"given":"Chien\u2010Boon","family":"Jong","sequence":"first","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital Hsin\u2010Chu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung\u2010Yuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin\u2010Liang","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation National Taiwan University Hospital Hsin\u2010Chu Branch Hsin\u2010Chu Taiwan"},{"name":"Department of Physical Medicine and Rehabilitation National Taiwan University College of Medicine Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mu\u2010Yang","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital Hsin\u2010Chu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang\u2010Ying","family":"Su","sequence":"additional","affiliation":[{"name":"Biotechology R&amp;D Center National Taiwan University Hospital Hsin\u2010Chu Branch Hsin\u2010Chu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan\u2010Chun","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Emergency and Critical Care Medicine School of Medicine National Yang\u2010Ming University Taipei Taiwan"},{"name":"Division of Cardiology Heart Center Cheng Hsin General Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei\u2010Hsian","family":"Yin","sequence":"additional","affiliation":[{"name":"Division of Cardiology Heart Center Cheng Hsin General Hospital Taipei Taiwan"},{"name":"Faculty of Medicine School of Medicine National Yang Ming University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih\u2010Hung","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen\u2010Wen","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Medicine National Yang\u2010Ming University Taipei Taiwan"},{"name":"Cardiology Division of Cardiovascular Medical Center Far Eastern Memorial Hospital New Taipei City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo\u2010Yung","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine Cardiovascular Center Taichung Veterans General Hospital Taichung Taiwan"},{"name":"College of Medicine China and Chung Shan Medical University Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan\u2010Cheng","family":"Chang","sequence":"additional","affiliation":[{"name":"Graduate Institute of Biomedical Sciences China Medical University Taichung Taiwan"},{"name":"Division of Cardiovascular Medicine China Medical University Hospital Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juey\u2010Jen","family":"Hwang","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Department of Internal Medicine National Taiwan University College of Medicine and Hospital Taipei Taiwan"},{"name":"College of Medicine National Taiwan University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih\u2010Cheng","family":"Wu","sequence":"additional","affiliation":[{"name":"Cardiovascular Center National Taiwan University Hospital Hsin\u2010Chu Branch Hsin\u2010Chu Taiwan"},{"name":"College of Medicine National Taiwan University Taipei Taiwan"},{"name":"Institute of Biomedical Engineering National Tsing\u2010Hua University Hsin\u2010Chu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-S007"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.009098"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1304501"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01448-6"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01802-2"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs217"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318235eb4d"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-015-0189-0"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-015-0305-1"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2017.04.008"},{"key":"e_1_3_2_12_2","volume-title":"Identification, Evaluation, and Treatment of Overweight and Obesity in Adults in Taiwan","author":"Department of Health","year":"2003","unstructured":"Department of Health . Identification, Evaluation, and Treatment of Overweight and Obesity in Adults in Taiwan. Taipei, Taiwan: Department of Health; 2003."},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-1736"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2016-000369"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.09.030"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.3904\/kjim.2012.27.2.180"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.06.019"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.01058.2004"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-S008"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-38248"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.2337\/db14-0694"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.82.12.4460"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.118.011215","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:42:59Z","timestamp":1715600579000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.118.011215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,2]]},"references-count":21,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2019,4,2]]}},"alternative-id":["10.1161\/JAHA.118.011215"],"URL":"https:\/\/doi.org\/10.1161\/jaha.118.011215","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,2]]},"assertion":[{"value":"2018-10-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e011215"}}