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Atherosclerosis burden in patients with acute chest pain: obesity paradox

Kongkiat Chaikriangkrai1, Mahwash Kassi1, Sayf Khaleel Bala2

  • 1Department of Medicine, The Methodist Hospital, Houston, TX 77030, USA.

ISRN Obesity
|February 21, 2014
PubMed

Insights

The obesity paradox, where obesity is linked to better outcomes, was observed in symptomatic chest pain patients. Higher obesity metrics were inversely associated with moderate-to-severe coronary artery calcification.

Area of Science:

  • Cardiology
  • Radiology
  • Public Health

Background:

  • The obesity paradox, a counterintuitive finding where obesity is associated with improved survival in certain diseases, is well-documented in coronary artery disease, primarily in asymptomatic individuals.
  • The relationship between obesity and coronary artery calcification (CAC) in symptomatic patients presenting with acute chest pain has been less explored.

Purpose of the Study:

  • To investigate the existence of the obesity paradox in symptomatic patients with acute chest pain undergoing coronary artery calcium (CAC) scoring.
  • To determine if obesity is inversely associated with moderate-to-severe coronary calcification in this specific patient cohort.

Main Methods:

  • A cohort of 1030 patients presenting with acute chest pain to the emergency department were evaluated using multidetector cardiac CT.
  • Coronary artery calcification (CAC) scores were assessed, with absent-to-mild calcification (CAC score < 100) used as the reference group.
  • Multivariable analysis was employed to examine the association between obesity metrics (including BMI, body weight, and body surface area) and moderate-to-severe coronary calcification (CAC score ≥ 100).

Main Results:

  • Obesity was found to be inversely associated with moderate-to-severe coronary calcification (CAC score ≥ 100) in patients with acute chest pain (OR 0.564; P = 0.002).
  • Higher body mass index (BMI) (OR 0.945; P < 0.001), body weight (OR 0.987; P = 0.001), and body surface area (OR 0.582; P = 0.020) were also inversely associated with significant coronary calcification.
  • These findings suggest the obesity paradox extends to symptomatic patients assessed for coronary artery calcium.

Conclusions:

  • This study provides evidence that the obesity paradox is applicable to symptomatic patients presenting with acute chest pain and undergoing coronary artery calcium scoring.
  • The observed inverse relationship between obesity indicators and moderate-to-severe coronary calcification in this population warrants further investigation.
  • The underlying biological mechanisms driving the obesity paradox in this context remain to be elucidated.

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