Obesity, body fat and coronary atherosclerosis

https://doi.org/10.1016/j.ijcard.2003.11.007Get rights and content

Abstract

Background: Recent prospective studies have provided compelling evidence that obesity is a risk factor for the occurrence of clinical coronary events. However, the link between angiographically determined coronary atherosclerosis and obesity still remains controversial. We conducted this cross-sectional study in a clinical setting to investigate the relation of the obesity and body fat (BF) with angiographically defined coronary atherosclerosis. Patients and Methods: Six hundred and seventy-three men (median age 64 years) and four hundred and twenty-eight women (median age 69 years) who underwent coronary angiography for suspected or known coronary heart disease were analyzed. The body mass index (BMI) and the BF were used as main exposure variables, and either the presence of significant (≥50%) coronary diameter stenosis or a coronary artery disease severity score were defined as outcome variables, in a sex-specific logistic regression analysis. Results: Among male patients, BF was slightly higher with increasing number of vessels involved (adjusted P for trend <0.05). In contrast, BMI showed no association with presence and severity of coronary artery disease (CAD). The odds ratios (ORs) for the presence of significant stenosis across quartiles of BMI were 1.0 (reference), 0.9, 1.1 and 0.7 (adjusted P for trend 0.61). This result did not differ between younger and older men. Among females, however, both BF and BMI were not significantly associated with an increasing number of vessels involved. Conclusion: These results suggested that BF may be predictive of an increasing number of coronary vessels involved among male patients, but not among female patients. This study failed to detect a positive association of presence and severity of CAD with BMI.

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

References (57)

  • K.F. McFarland et al.

    Risk factors and noncontraceptive estrogen use in women with and without coronary disease

    Am. Heart J.

    (1989)
  • M. Zamboni et al.

    Relation of body fat distribution in men and degree of coronary narrowings in coronary artery disease

    Am. J. Cardiol.

    (1992)
  • H. Hauner et al.

    Body fat distribution and its association with metabolic and hormonal risk factors in women with angiographically assessed coronary artery disease. Evidence for the presence of a metabolic syndrome

    Atherosclerosis

    (1994)
  • A.F. Salel et al.

    The importance of type IV hyperlipoproteinemia as a predisposing factor in coronary artery disease

    Am. J. Med.

    (1974)
  • L. Wallentin et al.

    Aberrations in lipoprotein lipids in men with coronary artery disease and the influence of obesity, smoking and beta-adrenoceptor blocking drugs

    Atherosclerosis

    (1985)
  • S. Lemieux et al.

    Sex differences in the relation of visceral adipose tissue accumulation to total body fatness

    Am. J. Clin. Nutr.

    (1993)
  • B.B. Duncan et al.

    Correlates of body fat distribution: variation across categories of race, sex, and body mass in the Atherosclerosis Risk in Communities Study

    Ann. Epidemiol.

    (1995)
  • L. Gruberg et al.

    The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox?

    J. Am. Coll. Cardiol.

    (2002)
  • K.S. Kim et al.

    A comparison between BMI and Conicity index on predicting coronary heart disease: the Framingham Heart Study

    Ann. Epidemiol.

    (2000)
  • J.E. Manson et al.

    A prospective study of obesity and risk of coronary heart disease in women

    N. Engl. J. Med.

    (1990)
  • W.C. Willett et al.

    Weight, change, and coronary heart disease in women. Risk within the ‘normal’ weight range

    JAMA

    (1995)
  • D.K. Dey et al.

    Obesity in 70-year-old subjects as a risk factor for 15-year coronary heart disease incidence

    Obes. Res.

    (2003)
  • R.J. Kuczmarski et al.

    Increasing prevalence of overweight among US adults: the National Health and Nutrition Examination Surveys, 1960 to 1991

    JAMA

    (1994)
  • R.P. Troiano et al.

    Overweight prevalence and trends for children and adolescents: the National Health and Nutrition Examination Surveys, 1963 to 1991

    Arch. Pediatr. Adolesc. Med.

    (1995)
  • T.A. Pearson

    Coronary arteriography in the study of the epidemiology of coronary artery disease

    Epidemiol. Rev.

    (1984)
  • J.M. Hodgson et al.

    Coronary atherosclersis in relation to body fatness and its distribution

    Int. J. Obes. Relat. Metab. Disord.

    (1994)
  • D. Reed et al.

    Predictors of arteriographically defined coronary stenosis in the Honolulu Heart Program. Comparisons of cohort and arteriography series analyses

    Am. J. Epidemiol.

    (1991)
  • L. Lapidus et al.

    Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden

    BMJ

    (1984)
  • Cited by (27)

    • Increased Arterial PET/CT <sup>18</sup>F-Fluorodeoxyglucose Uptake in Obese and Overweight Patients

      2021, Medecine Nucleaire
      Citation Excerpt :

      In the last decades, research into the pathology of atherosclerosis has improved our understanding of the disease. A large body of evidence from epidemiological studies has established a connection between obesity and atherosclerosis [3]. Obesity was found to accelerate the progression of atherosclerosis in both adolescent and adult population [4,5].

    • BMI and coronary heart disease: No difference according to sex

      2015, The Lancet Diabetes and Endocrinology
    • The association between body mass index and coronary artery disease severity: A comparison of black and white patients

      2014, American Heart Journal
      Citation Excerpt :

      Higher risk factor prevalence in black patients within our sample is consistent with previous studies evaluating racial disparities in CAD risk factors.2-4 Although the lower prevalence of angiographic CAD in black patients2-4 and inconsistent associations between BMI and obstructive CAD10-15 have been shown before, the comparable relationship of BMI and CAD between black and white patients revealing a significantly lower likelihood for CAD among the morbidly obese had not yet been evaluated. Furthermore, the dichotomous (obese vs nonobese) analysis of angiographic CAD prevalence obscures the subtleties of the same analysis stratified instead by BMI classification.

    • Influence of body mass index on extent of coronary atherosclerosis and cardiac events in a cohort of patients at risk of coronary artery disease

      2011, Nutrition, Metabolism and Cardiovascular Diseases
      Citation Excerpt :

      First, despite poor baseline clinical characteristics of obese and overweight patients, BMI was not significantly associated with either CAD scores; in other words, the extent of coronary atherosclerosis was similar. This finding confirms and widens the results of previous angiographic studies [10–15]. Niraj et al. [22] gives a possible explanation, since obese patients in the aforementioned study are referred for coronary angiography at a younger age, and therefore show an earlier stage of the disease.

    • The associations between visceral fat and calcified atherosclerosis are stronger in women than men

      2010, Atherosclerosis
      Citation Excerpt :

      Overweight and obesity are associated with a higher incidence of many CVD risk factors such as hypertension, diabetes, hypercholesterolemia, and cigarette smoking and obesity is a significant risk factor for CHD [2,21,35]. Fewer studies have examined the association of obesity with coronary atherosclerosis [1]. Calcium due to atherosclerosis in the coronary arteries is a surrogate marker of the total coronary atherosclerotic burden.

    View all citing articles on Scopus
    View full text