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Published on: August 28, 2018
Relation between obesity and severity of coronary artery disease in patients undergoing coronary angiography
Ronen Rubinshtein1, David A Halon, Ronen Jaffe
1The Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel. adironen@netvision.net.il
Insights
Obese patients undergoing coronary angiography were younger and had less high-risk coronary anatomy (HRCA). This suggests obesity may be a negative predictor of HRCA, potentially explaining the "obesity paradox" in cardiac outcomes.
Area of Science:
- Cardiology
- Public Health
- Metabolic Syndrome
Background:
- Obesity is a growing public health concern associated with cardiovascular disease.
- The relationship between body mass index (BMI) and coronary artery disease (CAD) severity remains complex.
- Understanding these associations is crucial for risk stratification and patient management.
Purpose of the Study:
- To investigate the association between BMI and the extent of coronary artery disease (CAD).
- To determine the frequency of high-risk coronary anatomy (HRCA) across different BMI categories.
- To identify predictors of HRCA and explore the impact of obesity on mortality.
Main Methods:
- A retrospective analysis of 928 patients undergoing coronary angiography.
- Patients were categorized into five BMI subgroups: low, normal, overweight, obese, and severely obese.
- High-risk coronary anatomy (HRCA) was defined as left main stenosis or significant three-vessel disease. Multivariate regression was used to identify predictors.
Main Results:
- Obese patients (BMI ≥30 kg/m²) were younger and had a lower prevalence of HRCA (23% vs. 37%, p=0.0002).
- Independent predictors of HRCA included older age, male gender, diabetes mellitus, and hyperlipidemia.
- Obesity was a significant negative independent predictor of HRCA (p=0.02).
- Late mortality (30-36 months) was similar between obese and non-obese patients but higher in those with HRCA.
Conclusions:
- Obese patients referred for coronary angiography present with less severe coronary artery disease.
- Obesity may be a protective factor against developing high-risk coronary anatomy, potentially at an earlier disease stage.
- These findings may help explain the observed
- obesity paradox
- in short-term outcomes following cardiac procedures.
Abstract:
We examined the relations among body mass index (BMI), extent of coronary artery disease, and frequency of high-risk coronary anatomy (HRCA) in 928 consecutive patients who underwent coronary angiography during a 6-month period. HRCA was defined as >or=50% stenosis of the left main coronary artery and/or significant 3-vessel coronary artery disease (>or=70% narrowing). BMI was classified into 5 subgroups: low (<21 kg/m(2)), normal (21 to 24 kg/m(2)), overweight (25 to 29 kg/m(2)), obese (30 to 34 kg/m(2)), and severely obese (>or=35 kg/m(2)). Obese patients (BMI >or=30 kg/m(2)) were younger (61.4 +/- 10.7 vs 65.3 +/- 11.4 years, p <0.0001) and had higher prevalences of hyperlipidemia, systemic hypertension, and diabetes mellitus. HRCA was present less often in obese patients (56 of 245, 23%, vs 250 of 683, 37%, p = 0.0002). Multivariate regression analysis showed that advancing age (p <0.0001), male gender (p = 0.007), diabetes mellitus (p = 0.0004), and hyperlipidemia (p = 0.0008) were independent predictors of high-risk anatomy, whereas obesity remained a significant negative independent predictor (p = 0.02). Late (30 to 36 months) mortality was not different between obese (6.9%) and nonobese (8.2%) patients but was significantly higher in patients with HRCA (12.4%) than in those without HRCA (5.6%, p = 0.0003). In conclusion, obese patients who were referred for coronary angiography were younger and had a lower prevalence of HRCA. Obese patients were probably referred for angiography at an earlier stage of their disease, thus explaining the "obesity paradox" in several reports of better short-term outcome in obese patients who undergo cardiac procedures.
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