Body mass index impacts the choice of lipid-lowering treatment with no correlation to blood cholesterol - Findings from 52 916 patients in the Dyslipidemia International Study (DYSIS)

A high body mass index (BMI) is associated with increased cardiovascular risk. We sought to identify whether BMI influences the choice of lipid-lowering treatment in a large, real-world cohort of 52916 patients treated with statins. The Dyslipidemia International Study (DYSIS) is a cross-sectional, observational, multicentre study in statin-treated patients ≥45years of age from 30 countries; 1.1% were underweight (BMI<18.5 kg/m²), 33.1% had normal weight (BMI 18.5-24.9 kg/m²), 41.5% were overweight (BMI 25-29.9 kg/m²), 17.1% had class I obesity (BMI 30.0-34.9 kg/m²), 5.0% had class II obesity (BMI 35-39.9 kg/m²), and 2.1% had class III obesity (≥40kg/m²). BMI correlated with high-density lipoprotein cholesterol (HDL-C) and triglycerides (Spearman's ρ: -0.147 and 0.170, respectively; P<0.0001 for both); however, there was no correlation with low-density lipoprotein cholesterol (LDL-C; ρ: 0.003; P=0.51). Statin intensity increased with increasing BMI (ρ: 0.13; P<0.001), an association that held after adjustment for comorbidities (OR: 2.4; 95% CI: 2.0-3.0) on BMI≥30kg/m² for atorvastatin equivalent ≥40mg/d.