Data underlying the publication "Association of body mass index and waist circumference with long-term mortality risk in 10,370 coronary patients and potential modification by lifestyle and health determinants"

Body adiposity is known to affect mortality risk in patients with coronary artery disease (CAD). We examined associations of body mass index (BMI) and waist circumference (WC) with long term mortality in Dutch CAD patients, and potential and effect modification of these associations by lifestyle and health determinants.<br>10,370 CAD patients (mean age ~65 y; 20% female; &gt;80% on cardiovascular drugs) from the prospective Alpha Omega Cohort and Utrecht Cardiovascular Cohort – Secondary Manifestations of ARTerial disease study were included. Cox models were used to estimate categorical and continuous associations (using restricted cubic splines) of measured BMI and WC with all-cause and cardiovascular mortality risk, adjusting for age, sex, smoking, alcohol, physical activity and educational level. Analyses were repeated in subgroups of lifestyle factors (smoking, physical activity, diet quality), education and health determinants (diabetes, self-rated health).<br>During ~10 years of follow-up (91,947 person-years), 3,553 deaths occurred, including 1,620 from cardiovascular disease. U-shaped relationships were found forBMI and mortality risk, with the lowest risk for overweight patients (BMI ~27 kg/m2). For obesity (BMI ≥30), the HR for all-cause mortality was 1.31 (95% CI: 1.11, 1.41) in male patients and 1.10 (95% CI: 0.92, 1.30) in female patients, compared to BMI 25-30 kg/m2. WC was also non-linearly associated with mortality, and HRs were 1.18 (95%CI:1.06, 1.30) in males and 1.31 (95%CI:1.05, 1.64) in females for the highest vs. middle category of WC. Results for cardiovascular mortality were mostly in line with the results for all-cause mortality. U-shaped associations were found in most subgroups, associations were moderately modified by physical activity, smoking and educational level.<br>CAD patients with obesity and a large WC were at increased risk of longterm CVD and all-cause mortality, while mildly overweight patients had the lowest risk. These associations were consistent across subgroups of patients with different lifestyles and health status.

既往研究表明，体脂状况会影响冠状动脉疾病（Coronary Artery Disease, CAD）患者的死亡风险。本研究旨在探讨荷兰CAD患者的体质量指数（Body Mass Index, BMI）与腰围（Waist Circumference, WC）和长期死亡率之间的关联，同时分析生活方式与健康决定因素对上述关联的潜在修饰效应。
本研究纳入了来自前瞻性队列研究「阿尔法欧米茄队列」与「乌得勒支心血管队列——动脉疾病继发性表现研究」的10370名CAD患者，其平均年龄约65岁，女性占比20%，超过80%的患者服用心血管药物。研究采用Cox比例风险模型，通过限制性立方样条分别评估连续型与分类变量形式下实测BMI与WC与全因死亡率及心血管死亡率的关联，并校正了年龄、性别、吸烟、饮酒、体力活动与教育水平等混杂因素。随后针对生活方式因素（吸烟、体力活动、饮食质量）、教育水平及健康决定因素（糖尿病、自我健康评估）分层，重复开展上述分析。
在平均约10年的随访期间（共计91947人年），共发生3553例死亡，其中1620例死于心血管疾病。BMI与死亡率之间呈现U型关联，超重患者（BMI约27kg/m²）的死亡风险最低。以BMI 25~30kg/m²为参照，肥胖患者（BMI≥30kg/m²）的全因死亡率风险比（Hazard Ratio, HR）在男性中为1.31（95% CI: 1.11, 1.41），女性中为1.10（95% CI: 0.92, 1.30）。WC与死亡率同样呈非线性关联，以腰围中间类别为参照，男性最高类别腰围对应的HR为1.18（95%CI:1.06, 1.30），女性则为1.31（95%CI:1.05, 1.64）。心血管死亡率的分析结果与全因死亡率的结果基本一致。多数分层亚组中均观察到U型关联，体力活动、吸烟与教育水平对上述关联存在中度修饰效应。
合并肥胖与大腰围的CAD患者长期心血管疾病（Cardiovascular Disease, CVD）及全因死亡风险升高，而轻度超重患者的死亡风险最低。上述关联在不同生活方式与健康状况的患者亚组中均保持一致。