title: Obesity and coronary artery disease: evaluation and treatment.
abstract: With the increasing prevalence of obesity, clinicians are now facing a growing population of patients with specific features of clinical presentation, diagnostic challenges, and interventional, medical, and surgical management. After briefly discussing the effect of obesity on atherosclerotic burden in this review, we will focus on strategies clinicians might use to ensure better outcomes when performing revascularization in obese and severely obese patients. These patients tend to present comorbidities at a younger age, and their anthropometric features might limit the use of traditional cardiovascular risk stratification approaches for ischemic disease. Alternative techniques have emerged, especially in nuclear medicine. Positron emission tomography-computed tomography might be the diagnostic imaging technique of choice. When revascularization is considered, features associated with obesity must be considered to guide therapeutic strategies. In percutaneous coronary intervention, a radial approach should be favoured, and adequate antiplatelet therapy with new and more potent agents should be initiated. Weight-based anticoagulation should be contemplated if needed, with the use of drug-eluting stents. An "off-pump" approach for coronary artery bypass grafting might be preferable to the use of cardiopulmonary bypass. For patients who undergo bilateral internal thoracic artery grafting, harvesting using skeletonization might prevent deep sternal wound infections. In contrast to percutaneous coronary intervention, lower surgical bleeding has been observed when lean body mass is used for perioperative heparin dose determination.
authors: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada.
authors: David
authors: D
authors: Garcia-Labbé
authors: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada; Faculty of Medicine, University of Sherbrooke, Québec, Québec, Canada.
authors: Emmeline
authors: E
authors: Ruka
authors: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada.
authors: Olivier F
authors: OF
authors: Bertrand
authors: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada.
authors: Pierre
authors: P
authors: Voisine
authors: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada.
authors: Olivier
authors: O
authors: Costerousse
authors: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada. Electronic address: paul.poirier@criucpq.ulaval.ca.
authors: Paul
authors: P
authors: Poirier
mesh_terms: D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D019468:Disease Management; D014943:Global Health; D006801:Humans; D009017:Morbidity / Q000639:trends; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D012307:Risk Factors