1. ¹Department of Medicine and the New York Obesity Research Center, St Luke's Roosevelt Hospital Center, New York, New York, USA
2. ²Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
3. ³Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
4. ⁴Department of Medicine, Division of Cardiology, Washington Hospital, St Louis, Missouri, USA
5. ⁵Department of Cardiovascular Medicine, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
6. ⁶Infectious Diseases, Astellas Pharma Global Development, Inc., Deerfield, Illinois, USA
7. ⁷Department of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
8. ⁸Division of Cardiology, Department of Medicine, University of Alabama at Birmingham Medical Center, Birmingham, Alabama, USA
9. ⁹Department of Medicine, University of Vermont, Burlington, Vermont, USA
10. ¹⁰Department of Medicine, Division of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA

Correspondence: Jeanine B. Albu (jba1@columbia.edu)

A complete list of the BARI 2D Study Group is groups is provided in refs. 16 and 27.

Received 5 December 2009; Accepted 18 August 2009; Published online 29 October 2009.

Abstract

The impact of obesity on cardiovascular disease (CVD) outcomes in patients with type 2 diabetes mellitus (T2DM) and established coronary artery disease (CAD) is controversial; whether BMI and/or waist circumference correlate with atherothrombotic risk factors in such patients is uncertain. We sought to evaluate whether higher BMI or waist circumference are associated with specific risk factors among 2,273 Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) study participants with T2DM and documented CAD (baseline data, mean age 62 years, 66% non-Hispanic white, 71% men). Multiple linear regression models were constructed after adjusting for sex, age, race/ethnicity, US vs. non-US site, diabetes duration, exercise, smoking, alcohol, and relevant medication use. First-order partial correlations of BMI with risk factors after controlling for waist circumference and of waist circumference with risk factors after controlling for BMI were also evaluated. Ninety percent of the patients were overweight (BMI 25 kg/m²); 68% of men and 89% of women had high-risk waist circumference measures (102 and 88 cm, respectively). BMI and waist circumference, in separate models, explained significant variation in metabolic (insulin, lipids, blood pressure (BP)) and inflammatory/procoagulation (C-reactive protein, PAI-1 activity and antigen, and fibrinogen) risk factors. In partial correlation analyses BMI was independently associated with BP and inflammatory/procoagulation factors, waist circumference with lipids, and both BMI and waist circumference with insulin. We conclude that, in cross-sectional analyses, both BMI and waist circumference, independently, are associated with increased atherothrombotic risk in centrally obese cohorts such as the BARI 2D patients with T2DM and CAD.