Severity of coronary artery disease in obese patients undergoing coronary angiography: "obesity paradox" revisited.
BACKGROUND
Recent studies have highlighted the existence of an 'obesity paradox' in patients undergoing coronary angiography, i.e., a high body mass Index (BMI) is associated with less severe coronary lesions. We sought to confirm the existence of this phenomenon in the US patient population.


METHODS
Study subjects included 770 consecutive patients (470 men, 428 African-Americans, 212 Caucasians) referred for coronary angiography to a tertiary care center. Duke myocardial jeopardy score, a prognostication tool predictive of 1-year mortality in coronary artery disease (CAD) patients, was assigned to angiographic data. Patients were classified according to their BMI (kg/m2) as normal (21-24), overweight (25-29), obesity class I (30-34), class II (35-39) and class III (40 or above).


RESULTS
Patients in the increasing obesity class had a higher prevalence of diabetes, hypertension and dyslipidemia and were more likely to be women. A negative correlation was observed between BMI and age (R = - 0.15 p < 0.001) as well as between BMI and Duke Jeopardy score (r = - 0.07, p < 0.05) indicating that patients with higher BMI were referred for coronary angiography at a younger age, and had a lower coronary artery disease (CAD) burden. BMI was not an independent predictor of coronary lesion severity on multivariate stepwise linear regression analysis.


CONCLUSIONS
Obese patients are referred for coronary angiography at an earlier age and have a lower CAD burden lending further credence to the existence of an apparent "obesity paradox". However, obesity per se, after adjustment for comorbidities, is not an independent predictor of severity of coronary artery disease.
Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan, USA.
Ashutosh
A
Niraj
Jyotiranjan
J
Pradhan
Jyotiranjan
J
Pradahan
Hesham
H
Fakhry
Vikas
V
Veeranna
Luis
L
Afonso
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D011237:Predictive Value of Tests; D015995:Prevalence; D012107:Research Design; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology