title: The association between body mass index and coronary artery disease severity: a comparison of black and white patients.
abstract: BACKGROUND
  Despite known associations between obesity and cardiovascular disease, the relationship between obesity as reflected by body mass index (BMI) and angiographic coronary artery disease (CAD) is not fully understood. Moreover, this relationship has not been adequately defined in black patients, a group demonstrated to have lower rates of angiographic CAD despite higher rates of CAD risk factors, cardiovascular events, and CAD-related mortality.
  
  
  METHODS
  Using an angiography database from an academic hospital, we studied patients undergoing first-time, nonemergent coronary angiography. From this cohort, we selected those without previous CAD diagnosis and with complete anthropomorphic measures and outcome data. Using models that controlled for patient demographics and CAD risk factors, we compared rates of angiographic CAD for blacks and whites by BMI.
  
  
  RESULTS
  Black patients had higher rates of CAD risk factors, including obesity and morbid obesity. Nevertheless, black patients were less likely to have a significant stenosis than white patients. Morbid obesity was associated with significantly less CAD in both race groups. Controlling for black-white differences in BMI and the prevalence of morbid obesity did not change the odds ratio for CAD among black patients.
  
  
  CONCLUSIONS
  Racial differences in BMI and prevalence of morbid obesity do not contribute to black-white differences in CAD detected during elective angiography. The paradoxical association of morbid obesity with a lower burden of atherosclerosis may be attributed in part to the limitations of noninvasive screening in the morbidly obese and subsequent referral of patients without disease for angiography.
authors.affiliation: Department of Public Health Leadership, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: Caleb.Stalls@northwestern.edu.
authors.forename: Caleb M
authors.initials: CM
authors.lastname: Stalls
authors.affiliation: Department of Public Health Leadership, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Medicine, University of California at San Francisco, San Francisco, CA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Triplette
authors.affiliation: Department of Public Health Leadership, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Viera
authors.affiliation: Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Pathman
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.affiliation: Cardiology Division, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; St. Vincent Medical GroupoT/The Care Group, Indianapolis, IN.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Rossi
mesh_terms: D001741:Black or African American; D015992:Body Mass Index; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000208:ethnology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000208:ethnology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D044465:White People