title: Relation between obesity and severity of coronary artery disease in patients undergoing coronary angiography.
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.
authors.affiliation: The Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel. adironen@netvision.net.il
authors.forename: Ronen
authors.initials: R
authors.lastname: Rubinshtein
authors.forename: David A
authors.initials: DA
authors.lastname: Halon
authors.forename: Ronen
authors.initials: R
authors.lastname: Jaffe
authors.forename: Johnny
authors.initials: J
authors.lastname: Shahla
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D012720:Severity of Illness Index; D012737:Sex Factors