title: Biomarker evaluation as a potential cause of gender differences in obesity paradox among patients with STEMI.
abstract: BACKGROUND
  Obesity with its worldwide growing prevalence is an established cardiovascular risk factor with increased morbidity and mortality. However, the phenomenon, that mild to moderate obesity seems to represent a protective effect on diseases has been termed the "obesity paradox".
  
  
  METHODS
  We retrospectively assessed 529 patients (72.6% male, mean age 59.7±12.7years) admitted with ST-elevation myocardial infarction (STEMI). The female and male study populations were separated into four body mass index (BMI) groups: ≤24.9kg/m(2), 25.0-29.9kg/m(2), 30.0-34.9kg/m(2) and ≥35.0kg/m(2). Blood samples of high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were analyzed.
  
  
  RESULTS
  With increasing BMI group the rate of major adverse cardiac events (MACE) decreased in all patients (test for trend p=0.041). No gender difference between MACE and BMI could be noticed (p=0.16). A higher risk for MACE was indicated in group BMI ≤18.5kg/m(2) in comparison to group BMI 25.0-29.9kg/m(2) (OR: 7.93; 95% CI: 1.75-35.89; p=0.0091), whereas group BMI 30.0-34.9kg/m(2) was significant associated with a lower risk in comparison to group BMI 25.0-29.9kg/m(2) (OR: 0.65; 95% CI: 0.21-1.96; p=0.044). An association between HDL-c (p=0.55) or LDL-c (p=0.10) and MACE could not be detected.
  
  
  CONCLUSIONS
  The study demonstrates that patients with STEMI and a BMI of 30.0-34.9kg/m(2) have a decreased risk for MACE compared to patients with normal BMI. No gender related differences were indicated. An association between MACE and lipoproteins could not be detected.
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: stefan.baumann@umm.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baumann
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: johanna-koepp@web.de.
authors.forename: Johanna
authors.initials: J
authors.lastname: Koepp
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: tobias.becher@umm.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Becher
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: aydin.huseynov@umm.de.
authors.forename: Aydin
authors.initials: A
authors.lastname: Huseynov
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: Katharina-Bosch@web.de.
authors.forename: Katharina
authors.initials: K
authors.lastname: Bosch
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: michael.behnes@umm.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Behnes
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: christian.fastner@umm.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Fastner
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: Ibrahim.el-battrawy@umm.de.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: El-Battrawy
authors.affiliation: Department of Internal Medicine I, Cardiology and Angiology, Giessen University, Giessen, Germany. Electronic address: matthias.renker@web.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Renker
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: siegfried.lang@medma.uni-heidelberg.de.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Lang
authors.affiliation: Institute of Medical Statistics and Biometry, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. Electronic address: christel.weiss@medma.uni-heidelberg.de.
authors.forename: Christel
authors.initials: C
authors.lastname: Weiß
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: martin.borggrefe@umm.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: ralf.lehmann@umm.de.
authors.forename: Ralf
authors.initials: R
authors.lastname: Lehmann
authors.affiliation: First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: ibrahim.akin@umm.de.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D016009:Chi-Square Distribution; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D009765:Obesity / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL
keywords: Body mass index; Major adverse cardiac events; Obesity; ST-segment elevation myocardial infarction