title: Obesity and coronary artery calcification: Can it explain the obesity-paradox?
abstract: The inverse relationship between obesity and adverse cardiovascular outcomes has been coined the 'obesity-paradox'. We sought to determine the relationship between measures of obesity [body mass index (BMI), body surface area (BSA) and body fat percentage (BF%)] and coronary artery calcification (CAC). We retrospectively analyzed patients who underwent CAC using the Agatston score. Baseline demographics were collected and BMI, BSA and BF% were calculated. A two-stage regression modeling approach was used to evaluate the association between BMI, BSA, BF% and Agatston score. Of the 6661 patients [mean age = 57.1 ± 10.8 years, men = 54.3%, median Agatston score = 14 (0, 163)], 0.1% were underweight, 21.3% had normal BMI, 39.1% were overweight and 39.4% were obese. The mean BMI, BSA and BF% were 29.6 ± 6.1 kg/m(2), 1.97 ± 0.25 m(2) and 37 ± 10 %, respectively. There was an independent association between the presence of CAC and BMI (5 kg/m(2) increments) (OR 1.05, CI 1.00-1.11, P = 0.038) and BF% (OR 2.38, CI 1.05-5.41, P = 0.038). Neither BMI categories nor large BSA independently predicted the presence of CAC. BF% predicted the extent of CAC in men but not in women, and higher BF% was associated with higher category of CAC severity in men only. BMI and BF% were independent predictors of the presence of CAC. BF% was associated with the extent of CAC and higher BF% was associated with higher category of CAC severity in men only. These results suggest that further study is needed to better understand the obesity-paradox.
authors: Department of Medicine, University of Ottawa, Ottawa, Canada.
authors: Ahmed
authors: A
authors: Aljizeeri
authors: Thais
authors: T
authors: Coutinho
authors: Ally
authors: A
authors: Pen
authors: Li
authors: L
authors: Chen
authors: Yeung
authors: Y
authors: Yam
authors: Robert
authors: R
authors: Dent
authors: Ruth
authors: R
authors: McPherson
authors: Benjamin J W
authors: BJ
authors: Chow
mesh_terms: D050154:Adiposity; D000368:Aged; D015992:Body Mass Index; D001830:Body Surface Area; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D065840:Protective Factors; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging