Association of Body Mass Index With Risk Factor Optimization and Guideline-Directed Medical Therapy in US Veterans With Cardiovascular Disease

Background: Obesity is a growing epidemic that has been linked to the development of cardiovascular disease (CVD). Guideline-directed medications for secondary prevention and risk factor control are recommended for patients with all forms of CVD. The association of body mass index (BMI) with use of medications for secondary prevention and risk factor control in patients with CVD are poorly understood. Methods and Results: We identified 1 122 567 patients with CVD receiving care in 130 Veterans Affairs facilities from October 1, 2013, to September 30, 2014. Five groups were stratified by BMI—underweight (BMI, <18.5 kg/m2), normal (BMI, 18.5–24.9 kg/m2), overweight (BMI, 25–29.9 kg/m2), obese (BMI, 30–39.9 kg/m2), and extremely obese (BMI, ≥40 kg/m2). A composite of 4 measures—blood pressure <140/90 mm Hg, hemoglobin A1c ≤9% in diabetic patients, statin use, and antiplatelet use—termed optimal medial therapy (OMT) was compared among groups. Multivariable logistic regression was performed with normal BMI as ...