Obesity, body fat and coronary atherosclerosis
Introduction
Previous trials showed inconsistent results regarding the association of obesity with atherosclerosis and coronary artery disease (CAD), despite overwhelming evidence of its association with CAD risk factors [1]. Recent long-term large-scale prospective studies have provided compelling evidence that obesity, as assessed by the body mass index (BMI) or relative body weight, is a risk factor for the occurrence of clinical coronary events [2], [3], [4]. Long-term follow-up studies found that obesity may be associated with CHD independently of other risk factors [5], [51], [54], [57]. The increasing prevalence of obesity among adults [6] and youths [7] and the recognition of the role of central adiposity have directed renewed attention to the relation of obesity to atherosclerosis and CHD.
However, the link between angiographically determined coronary atherosclerosis and obesity still remains controversial [8], and the overall trend demonstrates the predominance of negative over positive studies. In their discussion of the results, some investigators claim that obesity may be related to processes that influence acute clinical events, rather than atherosclerosis [9], whereas others state that potential methodological issues in arteriography series may have influenced results [10].
Growing attention has been paid to particular patterns of fat distribution (i.e., abdominal, central or visceral obesity) and body structure as a powerful predictor of both clinical coronary events [11] and angiographically documented CAD, independent of obesity per se [12], [13]. The objective of the present study was to examine the association of obesity and body fat (BF), measured by bioelectrical impedance analysis (BIA), with coronary atherosclerosis among men and women undergoing coronary angiography for suspected or known coronary heart disease.
Section snippets
Study subjects, clinical examination, study variables and laboratory methods
In this cross-sectional study, we allocated 1101 patients (673 men and 428 women) who, between August 2001 and November 2001, underwent coronary angiography at the cardiology department in Wels General Hospital, which is a 1050-bed tertiary referral center in Austria. The study group comprised all patients referred to our institution for coronary angiography during this period.
Most patients were referred due to symptoms or clinical signs of CAD. Patients were eligible if they were 30 years of
Results
Selected characteristics of 1101 patients undergoing coronary angiography according to BMI and the association of BMI with other potential coronary risk factors is shown in Table 1. Men with higher BMI tended to have higher BF, and to have a greater prevalences of diabetes and hypertension (P<0.05); an inverse trend without significance was noted for LDL-cholesterol with higher levels in the lower BMI groups. Women with higher BMI were characterized by higher BF and greater prevalences of
Summary of results
The present study focuses on the effects of obesity on coronary atherosclerosis, consolidates previously reported results, adds about 1100 cases (including over 400 women) to the analyses and examines the effects of BMI and body fatness on CAD. The results failed to detect a positive association of presence and severity of CAD with BMI, but suggested that body fatness may be predictive of an increasing number of coronary vessels involved among male but not female patients. The hypothesis of a
Conclusions
Thus, while the present findings should be interpreted with caution, in particular, with respect to the positive association between BF and the number of coronary vessels involved observed for men, the study failed to detect a positive association of presence and severity of CAD (assessed angiographically) with BMI. These data confirm and expand the predominantly negative results regarding the relationship of obesity to atherosclerosis in angiographic studies and challenge the hypothesis of a
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