The Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry

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Conference Proceeding

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Journal of the American College of Cardiology


Background: Associations between body mass index (BMI) and adverse cardiovascular (CV) events are unclear with some evidence suggesting an “obesity paradox,” such that patients with coronary artery disease (CAD) and a higher BMI may have better outcomes. We used data from the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) registry to evaluate CAD burden and clinical outcomes based on BMI. Methods: Patients in ADVANCE were stratified by BMI (normal <25 kg/m2, overweight 25-29.9 kg/m2, and obese ≥30 kg/m2). Baseline patient demographics, coronary computed tomography angiography (CCTA) findings, and fractional flow reserve derived from CTA (FFRCT) positivity (<0.8) were examined. An adjusted Cox proportional hazards model compared clinical outcomes between the groups using normal BMI as the reference. Results: Among 5,014 patients in ADVANCE with BMI data, 2,166 (43.2%) had a normal BMI, 1,883 (37.6%) were overweight, and 965 (19.2%) obese. Patients in the obese category were younger and had a higher burden of comorbidities (Table 1). Obese patients were less likely to have obstructive (≥50% stenosis) CAD by CCTA (P < 0.001). However, among the 4,665 patients with FFRCT measurements, hemodynamically significant CAD, as indicated by FFRCT <0.8, was similar across BMI categories (P = 0.113). After adjustment, the rate of major adverse CV events, including CV death, non-CV death, nonfatal myocardial infarction, and unplanned revascularization was similar regardless of BMI (P > 0.05 for all). Conclusion: Although obese patients in ADVANCE had a higher burden of comorbidities, they were less likely to have anatomically obstructive CAD but had a similar degree of hemodynamically significant CAD by FFRCT and similar rates of adverse events. This suggests that hemodynamic significance rather than anatomic stenosis may be a better predictor of CV outcomes among patients with obesity and CAD.





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