BMI and Coronary Heart Disease Risk Among Low-Income and Underinsured Diabetic Patients

OBJECTIVE: The association between obesity and coronary heart disease (CHD) risk remains debatable, and no studies have assessed this association among diabetic patients. The aim of our study was to investigate the association between BMI and CHD risk among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: The sample included 30,434 diabetic patients (10,955 men and 19,479 women) 30–95 years of age without a history of CHD or stroke in the Louisiana State University Hospital-Based Longitudinal Study. RESULTS: During a mean follow-up period of 7.3 years, 7,414 subjects developed CHD. The multivariable-adjusted hazard ratios for CHD across levels of BMI at baseline (18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and ≥40 kg/m(2)) were 1.00, 1.14 (95% CI 1.00–1.29), 1.27 (1.12–1.45), 1.54 (1.34–1.78), and 1.42 (1.23–1.64) (P(trend) < 0.001) in men and 1.00, 0.95 (0.85–1.07), 0.95 (0.84–1.06), 1.06 (0.94–1.20), and 1.09 (1.00–1.22) (P(trend) < 0.001) in women, respectively. When we used an updated mean or last visit value of BMI, the positive association between BMI and CHD risk did not change in men. However, the positive association of BMI with CHD changed to a U-shaped association in women when we used the last visit value of BMI. CONCLUSIONS: Our study suggests that there is a positive association between BMI at baseline and during follow-up with the risk of CHD among patients with type 2 diabetes. We indicate a U-shaped association between BMI at the last visit and the risk of CHD among women with type 2 diabetes.