Coronary artery disease
Relation Between Obesity and Severity of Coronary Artery Disease in Patients Undergoing Coronary Angiography

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We examined the relations among body mass index (BMI), extent of coronary artery disease, and frequency of high-risk coronary anatomy (HRCA) in 928 consecutive patients who underwent coronary angiography during a 6-month period. HRCA was defined as ≥50% stenosis of the left main coronary artery and/or significant 3-vessel coronary artery disease (≥70% narrowing). BMI was classified into 5 subgroups: low (<21 kg/m2), normal (21 to 24 kg/m2), overweight (25 to 29 kg/m2), obese (30 to 34 kg/m2), and severely obese (≥35 kg/m2). Obese patients (BMI ≥30 kg/m2) were younger (61.4 ± 10.7 vs 65.3 ± 11.4 years, p <0.0001) and had higher prevalences of hyperlipidemia, systemic hypertension, and diabetes mellitus. HRCA was present less often in obese patients (56 of 245, 23%, vs 250 of 683, 37%, p = 0.0002). Multivariate regression analysis showed that advancing age (p <0.0001), male gender (p = 0.007), diabetes mellitus (p = 0.0004), and hyperlipidemia (p = 0.0008) were independent predictors of high-risk anatomy, whereas obesity remained a significant negative independent predictor (p = 0.02). Late (30 to 36 months) mortality was not different between obese (6.9%) and nonobese (8.2%) patients but was significantly higher in patients with HRCA (12.4%) than in those without HRCA (5.6%, p = 0.0003). In conclusion, obese patients who were referred for coronary angiography were younger and had a lower prevalence of HRCA. Obese patients were probably referred for angiography at an earlier stage of their disease, thus explaining the “obesity paradox” in several reports of better short-term outcome in obese patients who undergo cardiac procedures.

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