title: Body mass index: a risk factor for unstable angina and myocardial infarction in patients with angiographically confirmed coronary artery disease.
abstract: BACKGROUND
  In patients with coronary artery disease (CAD), acute thrombosis frequently occurs in coronary arteries with only mild or moderate stenoses. Obesity increases the risk of atherosclerosis, but it is not known whether it also increases the risk of coronary thrombosis. We hypothesized that body mass index (BMI) might be an independent predictor of an acute coronary syndrome in patients with established coronary atherosclerosis.
  
  
  RESULTS
  Of 504 patients undergoing coronary angiography, those with evidence of >10% coronary artery stenoses were divided into 2 groups, with either stable (n=226) or unstable CAD (unstable angina or myocardial infarction; n=156). After adjusting for other risk factors (age, gender, blood pressure, lipid levels, insulin resistance, leptin, fibrinogen, C-reactive protein (CRP), CAD severity on angiography, smoking status, and a history of myocardial infarction or hypertension), BMI had a significant independent association with an acute coronary syndrome, with an odds ratio of 1.49 (P=0.014). This positive relation between BMI and the risk of acute coronary events was evident for even mildly elevated BMI values. Multivariate analysis also showed that CRP and the number of coronary lesions were independent predictors of risk of an acute coronary event.
  
  
  CONCLUSIONS
  In patients with established coronary atherosclerosis, BMI, as well as CRP and number of coronary lesions, are independently associated with acute coronary syndromes. There is evidence of increased risk even at mildly elevated BMI levels.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 1216 Second St SW, Rochester, Minn 55902, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Wolk
authors.forename: Peter
authors.initials: P
authors.lastname: Berger
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Virend K
authors.initials: VK
authors.lastname: Somers
mesh_terms: D000789:Angina, Unstable / Q000453:epidemiology*; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009203:Myocardial Infarction / Q000453:epidemiology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors