Register
Forgot your password?

Prognostic impact of obesity in patients with coronary heart disease who underwent coronary artery bypass grafting

Authors: Yakhyaeva K.B., Keren M.A., Zavalikhina T.V., Volkovskaya I.V., Sigaev I.Yu.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2025-19-3-362-371

For citation: Yakhyaeva K.B., Keren M.A., Zavalikhina T.V., Volkovskaya I.V., Sigaev I.Yu. Prognostic impact of obesity in patients with coronary heart disease who underwent coronary artery bypass grafting. Creative Cardiology. 2025; 19 (3): 362–371 (in Russ.). DOI: 10.24022/1997-3187-2025-19-3-362-371

Received / Accepted:  09.05.2025 / 17.07.2025

Keywords: coronary artery bypass grafting obesity body mass index



Subscribe 🔒

 

Abstract

Objective. To assess the prognostic role of obesity, determined by body mass index (BMI), in patients with coronary artery disease who underwent coronary artery bypass grafting (CABG).

Material and methods. The cohort retrospective study consistently included 2818 patients with stable coronary artery disease who underwent elective isolated CABG in 2018–2021. Patients were divided into five groups depending on BMI:

1) patients with normal BMI 18.5–24.9 kg/m2 (n = 503); 2) patients with elevated BMI 25–29.9 kg/m2 (n = 1175); 3) patients with stage 1 obesity (BMI 30–34.9 kg/m2) (n = 845); 4) patients with stage 2 obesity (BMI 35–39.9 kg/m2) (n = 225); 5) patients with stage 3 obesity (BMI ≥ 40 kg/m2) (n = 70). The study was conducted in 2 stages: in-hospital and remote (from 2 to 71 months, and the median follow-up period was 43.0 (30.0–54.0) months. The end point was mortality from any cause during the follow-up period from the moment of intervention.

Results. In the early postoperative period, the highest mortality rate after CABG was observed in patients with normal BMI (2.6%), and the lowest mortality was noted in the group of patients with grade I obesity (0.6%), p = 0.046. Patients with CHD with obesity, in comparison with patients without obesity, demonstrated a comparable level of postoperative complications (except for a higher frequency of acute renal failure), while hospital mortality after CABG in obese patients was significantly lower, regardless of its severity. When assessing the remote stage of observation, five-year overall survival in patients with normal BMI, excess BMI, obesity grades 1 and 2 is comparable, while with morbid obesity (BMI over 40 kg/m2) mortality was higher (p = 0.039).

Conclusion. In patients with obesity, regardless of its severity, there is a lower risk of hospital death, which confirms the obesity paradox. Remote results show a comparable risk of death in patients with normal body weight, excess BMI, obesity grades 1 and 2. However, patients with severe morbid obesity (BMI over 40 kg/m2) have worse remote survival. It is necessary to evaluate the independent effect of obesity, determined by BMI, on the prognosis of patients undergoing CABG.

References

  1. Obesity and overweight. World Health Organization (WHO). Fact Sheets. 2021 (in Russ.). https://www.who.int/ru/news-room/fact-sheets/detail/obesity-and-overweight (accessed May 1, 2025).
  2. Milyukov V.E., Bryukhanov V.A., Nguyen C.C. Morphofunctional analysis of the role of epicardial adipose tissue in the formation of the obesity paradox in chronic heart failure. Kardiologiia. 2024; 64 (3): 72–80 (in Russ.). DOI: 10.18087/cardio.2024.3.n2469
  3. Koshelskaya O.A., Kravchenko E.S., Naryzhnaya N.V., Kologrivova I.V., Krapivina A.S., Haritonova O.A. et al. Аdipocytes size of the epicardial adipose tissue in patients with coronary artery disease and coronary atherosclerosis: relationship with parameters of blood lipid transport function, carbohydrate metabolism and inflammatory markers. Kardiologiia. 2024; 64 (9): 48–57 (in Russ.). DOI: 10.18087/cardio.2024.9.n2691
  4. Gritsenko O.V., Chumakova G.A., Trubina E.V. The role of epicardial obesity in the development of left ventricular diastolic dysfunction. Kardiologiia. 2023; 63 (7): 32–38 (in Russ.). DOI: 10.18087/cardio.2023.7.n2120
  5. Shuvaev I.P., Asymbekova E.U., Sherstyannikova O.M., Akhmedyarova N.K., Rakhimov A.Z., Matskeplishvili S.T. The effect of fat metabolism disorders on severity of diastolic myocardial dysfunction in patients with ischemic heart diseases and metabolic syndrome. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2018; 19 (6): 800–810 (in Russ.). DOI: 10.24022/1810-0694-2018-19-6-800-810
  6. Shalov R.Z., Filatov A.G. Comorbid pathology and risk factors in patients with atrial fibrillation. Annaly Aritmologii. 2023; 20 (1): 43–51 (in Russ.). DOI: 10.15275/annaritmol.2023.1.5
  7. Keren M.A., Sigaev I.Yu., Osipova A.I., Volkovskaya I.V., Zavalikhina T.V., Avakova S.A. et al. Impact of chronic kidney disease on type of coronary artery bypass grafting and on the structure of postoperative complications in patients with coronary artery disease. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2023; 65 (4): 414–423 (in Russ.). DOI: 10.24022/0236-2791-2023-65-4-414-423
  8. Pogosova N.V., Oganov R.G., Boitsov S.A., Ausheva A.K., Sokolova O.Yu., Kursakov A.A. et al. Analysis of key indicators of secondary prevention in patients with coronary heart disease in Russia and Europe based on the results of the Russian part of the international multicenter study EUROASPIRE V. Cardiovascular Therapy and Prevention. 2020; 19 (6): 27–39 (in Russ.). DOI: 10.15829/1728-8800-2020-2739
  9. Jiang X., Xu J., Zhen S., Zhu Y. Obesity is associated with postoperative outcomes in patients undergoing cardiac surgery: a cohort study. BMC Anesthesiol. 2023; 23 (1): 3. DOI: 10.1186/s12871-022-01966-1
  10. Terada T., Johnson J.A., Norris C., Padway R., Weiyu Q., Sharma A.M. et al. Severe obesity is associated with increased risk of early complications and extended length of stay following coronary artery bypass grafting surgery. J. Am. Heart Assoc. 2016; 5 (6): e003282. DOI: 10.1161/JAHA.116.003282
  11. Yeung E., Smith S., Scharf M., Wung C., Harsha S., Lawson S. et al. BMI disparities in coronary artery bypass grafting outco-mes: a single center Society of Thoracic Surgeons (STS) database analysis. Surg. Pract. Sci. 2022; 10: 100110. DOI: 10.1016/j.sipas.2022.100110
  12. Beckmann A., Poehlmann M., Mayr P., Krane M., Boehm J. The burden of obesity in cardiac surgery: a 14 years' follow-up of 14.754 patients. J. Obes. 2024; 2024: 5564810. DOI: 10.1155/2024/5564810
  13. Lv M., Gao F., Liu B., Pandey P., Feng Y., Wang Y. et al. The effects of obesity on mortality following coronary artery bypass graft surgery: a retrospective study from a single center in China. Med. Sci. Monit. 2021; 27: e929912. DOI: 10.12659/MSM.929912
  14. Muhyieddeen A., Sharif Z., Rasheed O., Ranasinghe S., Chang J., Saleh K. Investigating the obesity paradox: patient outcomes in common cardiac procedures with obesity. Am. Heart J. 2024; 267: 131. DOI: 10.1016/j.ahj.2023.08.040
  15. Golukhova E.Z., Keren M.A., Sigaev I.Yu., Merzlyakov V.Yu., Petrosyan K.V., Alshibaya M.D et al. A dataset of labeled data from patients with stable coronary artery disease who underwent myocardial revascularization (coronary artery bypass grafting and coronary stenting) designed for training a neural network. Patent RF № 2022620223. 2022 (in Russ.).
  16. Ades P.A., Savage P.D. The obesity paradox: perception vs knowledge. Mayo Clin. Proc. 2010; 85 (2): 112–114. DOI: 10.4065/mcp.2009.0777
  17. Wang Z., Dong B., Hu J., Adegbija O., Arnold L.W. Exploring the non-linear association between BMI and mortality in adults with and without diabetes: the US National Health Interview Survey. Diabetic Medicine. 2020; 33 (12): 1691–1699. DOI: 10.1111/dme.13111
  18. Takagi H., Umemoto T.; ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. Overweight, but not obesity, paradox on mortality following coronary artery bypass grafting. J. Cardiol. 2016; 68 (3): 215–221. DOI: 10.1016/j.jjcc.2015.09.015
  19. Gurevitz C., Assali A., Mohsan J., Gmach Sh.F., Beigel R., Ovdat T. et al. The obesity paradox in patients with acute coronary syndromes over 2 decades – the ACSIS registry 2000–2018. Int. J. Cardiol. 2023; 380: 48–55. DOI: 10.1016/j.ijcard.2023.03.038
  20. Elbaz-Greener G., Rozen G., Carasso S., Kusniec F., Yarkoni M., Marai I. et al. The relationship between body mass index and in-hospital mortality in patients following coronary artery bypass grafting surgery. Front. Cardiovasc. Med. 2021; 8 (8):
  21. Yakhyaeva K.B., Keren M.A., Volkovskaya I.V. Causes of the reverse epidemiology of «obesity paradox» in patients with cardiovascular diseases. Creative Cardiology. 2025; 19 (2): 162–171 (in Russ.). DOI: 10.24022/1997-3187-2025-19-2-162-171
  22. Golukhova E.Z., Keren M.A., Volkovskaya I.V., Yakhyaeva K.B., Zavalikhina T.V., Avakova S.A. et al. Is there “obesity paradox” in coronary surgery? Effect of body mass index on hospital outcomes and three-year survival after coronary bypass surgery. Creative Cardiology. 2023; 17 (2): 247–255 (in Russ.). DOI: 10.24022/1997-3187-2023-17-2-247-255
  23. Bockeria L.A., Donakanyan S.A., Biniashvili M.B., Shvartz V.A., Petrosyan A.D., Glushko L.A. et al. Randomized clinical trial results: the alternative strategy of surgical treatment in patients with chronic ischemic heart disease with no options for complete myocardial revascularization. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2024; 66 (6): 801–809 (in Russ.). DOI: 10.24022/0236-2791-2024-66-6-801-809
  24. Shevchenko Yu.L., Ermakov D.Yu., Borshchev G.G., Vakhrameeva A.Yu. Two-year results of coronary bypass surgery and staged hybrid coronary revascularization in patients with coronary artery disease. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2024; 66 (5): 668–680 (in Russ.). DOI: 10.24022/0236-2791-2024-66-5-668-680
  25. Mamedova S.K., Merzlyakov V.Yu., Klyuchnikov I.V., Tetvadze I.V. Long-term outcomes of on-pump beating-heart coronary artery bypass grafting in patients with chronic coronary artery disease. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2022; 64 (6): 596–604 (in Russ.). DOI: 10.24022/0236-2791-2022-64-6-596-604
  26. Kishore B.K. Reverse epidemiology of obesity paradox: fact or fiction? Physiol. Rep. 2024; 12 (21): e70107. DOI: 10.14814/phy2.70107
  27. Rubino F., Cummings D.E., Eckel R.H., Cohen R.V., Wilding J.P.H., Brownet W.A. et al. Definition and diagnostic criteria of clinical obesity. Lancet. Diabetes Endocrinol. 2025; 13 (3): 221–262. DOI: 10.1016/S2213-8587(24)00316-4

About Authors

  • Kumushdzhan B. Yakhyaeva, Junior Researcher, Cardiologist; ORCID
  • Milena A. Keren, Dr. Med. Sci., Professor, Senior Researcher; ORCID
  • Tatyana V. Zavalikhina, Cand. Med. Sci., Chief Physician of the Institute of Coronary and Vascular Surgery (ICVS); ORCID
  • Irina V. Volkovskaya, Cand. Med. Sci., Head of the Consultative and Diagnostic Center of the ICVS; ORCID
  • Igor Yu. Sigaev, Dr. Med. Sci., Professor, Acting Director of the ICVS; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by