Association Between Body Mass Index and Age of Presentation With Symptomatic Coronary Artery Disease

Association of overweight and obesity with coronary risk factors and the presence of multivessel disease in patients with obstructive coronary artery disease - A nationwide registry study

Background

The growing prevalence of obesity is expected to increase the burden of coronary artery disease. This study examined the prevalence of overweight and obesity in patients with a first-time diagnosis of obstructive coronary artery disease in a contemporary population. The association of body-mass-index (BMI) with age, traditional risk factors, and the presence of multivessel disease were explored.

Methods and results

Using the Danish Nationwide registries, we identified 49,733 patients with a first-time diagnosis of obstructive coronary artery disease in the period 2012-2018. We investigated the association between BMI and coronary risk factors by multivariate logistic regression. Mean age was 65.8 ± 11.8 years, mean BMI was 27.5 kg/m2 ± 7.2, and 73.2 % were men. 66.3 % had a BMI ≥25 kg/m2 and 1.3 % were underweight. The prevalence of patients with BMI ≥25 kg/m2 decreased with increasing age and was 69 % in patients <50 year vs. 46.2 % in patients ≥80 years (p < 0.001). In all age groups, higher odds of BMI ≥25 kg/m2 were observed in males, former smokers, and patients with hypertension. In multivariate logistic regression, BMI ≥25 kg/m2 was not associated with presence of multivessel disease (p = 0.74).

Conclusion

In this large, nationwide study, 66.3 % of patients with first time diagnosis of obstructive coronary disease had BMI ≥25 kg/m2. Young patients had higher BMI and were more likely to be current smokers. Overweight or obesity was independently associated with the presence of diabetes and hypertension. BMI ≥25 kg/m2 was not independently associated with the presence of multivessel disease.

Modifiable and Non-Modifiable Risk Factors for Premature Coronary Heart Disease (PCHD): Systematic Review and Meta-Analysis

AIM

We aimed to compare the prevalence of modifiable and non-modifiable coronary heart disease (CHD) risk factors among those with premature CHD and healthy individuals.

METHODS

PubMed, CINAHL, Embase, and Web of Science databases were searched (review protocol is registered in PROSPERO CRD42020173216). The quality of studies was assessed using the National Heart, Lung and Blood Institute tool for cross-sectional, cohort and case-control studies. Meta-analyses were performed using Review Manager 5.3. Effect sizes for categorical and continuous variables, odds ratio (OR) and mean differences (MD)/standardised mean differences (SMD) with 95% confidence intervals (CI) were reported.

RESULTS

A total of n=208 primary studies were included in this review. Individuals presenting with premature CHD (PCHD, age ≤65 years) had higher mean body mass index (MD 0.54 kg/m2, 95% CI 0.24, 0.83), total cholesterol (SMD 0.27, 95% CI 0.17, 0.38), triglycerides (SMD 0.50, 95% CI 0.41, 0.60) and lower high-density lipoprotein cholesterol (SMD 0.79, 95% CI: -0.91, -0.68) compared with healthy individuals. Individuals presenting with PCHD were more likely to be smokers (OR 2.88, 95% CI 2.51, 3.31), consumed excessive alcohol (OR 1.40, 95% CI 1.05, 1.86), had higher mean lipoprotein (a) levels (SMD 0.41, 95% CI 0.28, 0.54), and had a positive family history of CHD (OR 3.65, 95% CI 2.87, 4.66) compared with healthy individuals. Also, they were more likely to be obese (OR 1.59, 95% CI 1.32, 1.91), and to have had dyslipidaemia (OR 2.74, 95% CI 2.18, 3.45), hypertension (OR 2.80, 95% CI 2.28, 3.45), and type 2 diabetes mellitus (OR 2.93, 95% CI 2.50, 3.45) compared with healthy individuals.

CONCLUSION

This meta-analysis confirms current knowledge of risk factors for PCHD, and identifying these early may reduce CHD in young adults.

Prevalence of obesity and overweight among type 2 diabetic patients in Bisha, Saudi Arabia

Context:

Obesity is a significant worldwide public health issue and one of the significant risk factors for type 2 diabetes and cardiovascular diseases.

Aims:

This study aims to determine the prevalence of obesity and overweight among type 2 diabetic patients, and explore the association between Body Mass Index (BMI), social demographics and time since diagnosis.

Settings and Design:

This study followed a cross-sectional study design in Bisha, Saudi Arabia.

Methods and Material:

Participants were identified by convenience sampling from 6 Primary Health Care Centers (PHCC) over a period of two weeks from March 16 to March 28, 2020.

Statistical Analysis Used:

Frequency and percentage were used to report the obesity prevalence. Chi-Square test was used to test the association between social demographics and time since diagnosis with BMI.

Results:

Obesity and overweight prevalence was 85.8% (n = 525), among which 27.9% (n = 171) were overweight, 57.8% were obese (n = 354), and only 13.2% (n = 81) had normal weight. A statistically significant difference between BMI and age was observed (P = 0.01). Differences between BMI and time since obesity diagnosis were statistically significant (P < 0.0001). Differences between BMI and time since type 2 diabetes diagnosis were not found to be statistically significant.

Conclusion:

There is a high prevalence of obesity and overweight among type 2 diabetic patients in Bisha. Differences in BMI were found to be statistically significant according to age, gender, education level and time since obesity diagnosis. Patient education programs and public health awareness about diabetes and obesity are highly recommended.

[Influence of age factor and age-associated predictors on remote results of coronary artery bypass grafting]

This study was undertaken to analyse long-term survival and its predictors, depending on age of patients who underwent isolated coronary aortic bypass grafting. Our study included a total of 177 consecutive patients operated on during 2014. For the purpose of statistical analysis, the patients were divided into two groups according to their age at the time of surgery: <60 years (n=96) and >60 years (n=81). The mean age in the groups <60 years and >60 years amounted to 54.5±2.9 years and 63.5±2.5 years, respectively. All data were obtained from the patients' medical histories, outpatient follow-up records, and operative reports. The average duration of follow-up in the overall cohort amounted to 5.1±1.7 years. Chronic obstructive pulmonary disease, peripheral artery disease, and acute impairment of cerebral circulation were of significantly less common occurrence in the younger patient cohort. However, the frequency of a body mass index of ≥30 kg/m2, unstable angina, previously endured myocardial infarction and left ventricular systolic dysfunction in the preoperative period appeared to be significantly higher in this population. At 5 years after surgery, freedom from survival amounted to 94.8% in patients younger than 60 years (5 patients) and to 90.1% (8 patients) in those aged 60 years and older (p<0.001). Based on the findings of a multivariate analysis, independent predictors of mortality turned out to be a history of myocardial infarction, chronic kidney disease, diabetes mellitus, chronic obstructive pulmonary disease, lesions of peripheral arteries and the trunk of the left coronary artery. The area under the receiver operating characteristic curve was 0.834 (p<0.001, 95% CI: 0.724-0.902). Despite the fact that coronary artery bypass grafting is an effective method of treatment of ischaemic heart disease for both groups, special attention should be paid to the development and improvement of preventive strategies aimed at decreasing the impact of specific risk factors for cardiovascular diseases such as diet, lifestyle, weight control, and more aggressive medical therapy in younger patients. It is necessary to elaborate a reasonable strategy and optimization of the choice of an optimal approach to myocardial revascularization for elderly patients with multivessel and truncal lesions of coronary arteries, which are potential risk factors of death in the postoperative period.

Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61

Background

Hyperglycemia in the setting of an acute coronary syndrome (ACS) impacts short term outcomes, but little is known about longer term effects. We therefore designed this study to firstly determine the association between hyperglycemia and short term and longer term outcomes in patients presenting with ACS and secondly evaluate the prognostic role of diabetes, body mass index (BMI) and the novel biomarker Cyr61 on outcomes.

Methods

The prospective Special Program University Medicine-Acute Coronary Syndrome (SPUM-ACS) cohort enrolled 2168 patients with ACS between December 2009 and October 2012, of which 2034 underwent PCI (93.8%). Patients were followed up for 12 months. Events were independently adjudicated by three experienced cardiologists. Participants were recruited from four tertiary hospitals in Switzerland: Zurich, Geneva, Lausanne and Bern. Participants presenting with acute coronary syndromes and who underwent coronary angiography were included in the analysis. Patients were grouped according to history of diabetes (or HbA1c greater than 6%), baseline blood sugar level (BSL; < 6, 6–11.1 and > 11.1 mmol/L) and body mass index (BMI). The primary outcome was major adverse cardiac events (MACE) which was a composite of myocardial infarction, stroke and all-cause death. Secondary outcomes included the individual components of the primary endpoint, revascularisations, bleeding events (BARC classification) and cerebrovascular events (ischaemic or haemorrhagic stroke or TIA).

Results

Patients with hyperglycemia, i.e. BSL ≥ 11.1 mmol/L, had higher levels of C-reactive protein (CRP), white blood cell count (WBC), creatinine kinase (CK), higher heart rates and lower left ventricular ejection fraction (LVEF) and increased N-terminal pro-brain natriuretic peptide. At 30 days and 12 months, those with BSL ≥ 11.1 mmol/L had more MACE and death compared to those with BSL < 6.0 mmol/L or 6.0–11.1 mmol/L (HR-ratio 4.78 and 6.6; p < 0.001). The novel biomarker Cyr61 strongly associated with high BSL and STEMI and was independently associated with 1 year outcomes (HR 2.22; 95% CI 1.33–3.72; Tertile 3 vs. Tertile 1).

Conclusions and relevance

In this large, prospective, independently adjudicated cohort of in all comers ACS patients undergoing PCI, both a history of diabetes and elevated entry glucose was associated with inflammation and increased risk of MACE both at short and long-term. The mediators might involve increased sympathetic activation, inflammation and ischemia as reflected by elevated Cyr61 levels leading to larger levels of troponin and lower LVEF.

Trial registration Clinical Trial Registration Number: NCT01000701. Registered October 23, 2009

The relationship between maternal characteristics and carotid intima-media thickness using an automated ultrasound technique

Objective: To investigate CIMT and its relationship with maternal demographic characteristics in healthy pregnancy. Methods: CIMT was measured using an au. Results: CIMT showed no relationship with gestational age (rho=-0.124, p=0.335), parity (Z=-0.055, p=0.960) and MAP (rho=0.110, p=0.393). A relationship was found between CIMT and maternal age (rho=0.277, p=0.028), booking BMI (rho=0.278, p=0.027), and BMI at time of study (rho=0.287, p=0.023). CIMT ranged from 0.30-0.80mm, the 97.5th percentile was 0.63 mm. Conclusion: In healthy pregnancy, we reported CIMT was related to BMI and maternal age but not parity or gestational age.

Coronary artery disease and body mass index: What is the relationship?

INTRODUCTION

Nowadays, obesity is considered an independent risk factor for the development of cardiovascular diseases (CVD), which has been presented as an important cause of worldwide morbidity and mortality, especially coronary artery disease (CAD). The objective of the study was to verify the association between body mass index (BMI) and severity of CAD, its risk factors and surgical and percutaneous treatment in patients hospitalized in cardiological units.

METHODS

An ambispective, cross-sectional study was performed with patients older than 18 years attended by nutrition in the cardiology units, who underwent coronary angiography. The severity of CAD was categorized into two distinct classifications (CAD Class I and II), considering the presence of CAD as lesions ≥50% and ≥70%. The nutritional status of the patient was established based on BMI according to the World Health Organization (WHO) for the total sample and group of adults, and according to the Pan American Health Organization (PAHO) for the elderly. Age, gender, presence of associated comorbidities, history of smoking, and performed procedures were collected in patients' records. For statistical analysis Kruskal Wallis and Chi-square tests were used, and Hodges-Lehmann estimate was used for the median. Comparisons and associations were considered significant when p < 0.05.

RESULTS

A total of 703 patients were included, of which 495 had arterial lesions ≥70% and 513 patients' lesions ≥50%. The average age was 61 years, women were older (63 vs 61; p = 0.008), had a higher BMI (28.16 kg/m² vs 26.68 kg/m², p = 0.001) and were more likely to have diabetes mellitus (DM) (p < 0.001), dyslipidemia (DSLP) (p < 0.001), and hypertension (HTN) (p = 0.001). The majority of the sample consisted of men, who more often underwent percutaneous coronary intervention (PCI) (53,9% vs 39%, p < 0.001), and were more likely to present more severe CAD (p < 0.001 and p = 0.003). In patients diagnosed with CAD the increase in BMI was positively associated with the presence of DM (p < 0.001), DSLP (p < 0.001) and HTN (p < 0.001), and negatively with age (p = 0.007). Patients with obesity III, were diagnosed with CAD, in average, 11 years earlier than patients with normal BMI (p = 0.05). Therefore, the higher the BMI, the lower the age at the moment of the examination in the total sample, and in the group of elderly, and this association was not found in adults. There was no significant association of BMI with the severity of CAD, or with PCI and coronary artery bypass grafting (CABG). The greater severity of CAD was positively associated with the presence of DM (p = 0.012 and p = 0.001), HTN (p = 0.033 and p = 0.003) and older age (p = 0.005 and p = 0.015). Patients who underwent CABG had a higher incidence of and HTN (p = 0.003), DM (p = 0.006), whereas patients who had PCI had a lower incidence of HTN (p = 0.021) and DM (p = 0.004).

CONCLUSION

Obesity was showed to be as an independent risk factor for the early incidence of CAD, which is strongly associated with the presence of comorbidities such as DM, HTN and DSLP. The greater severity of CAD and coronary interventions were associated with the presence of risk factors for CAD.

Relationship between high-sensitivity C-reactive protein and subclinical carotid atherosclerosis stratified by glucose metabolic status in Chinese adults

BACKGROUND

Atherosclerosis is an inflammatory disease. Many studies demonstrated that hyperglycemia is not only increased inflammatory response, but also is a cause of atherosclerosis, implying that glucose metabolic status may be an important stratification factor when analyzing the relationship between inflammatory levels and subclinical carotid atherosclerosis. The aim of the present study is to assess the relationship between inflammatory levels and subclinical carotid atherosclerosis, stratified by different glucose metabolic status in a general population.

METHODS

An assessment was performed in 7975 participants living in Tianjin, China. In the present study, we examined subclinical carotid atherosclerosis, as defined by increased carotid intima-media thickness [IMT] and plaques. Measurements were performed using a carotid artery B-mode ultrasound system. The glucose metabolic status was defined by the criteria of the American Diabetes Association, and high-sensitivity C-reactive protein (hs-CRP) as an inflammatory indicator, was measured by immunoturbidimetric assay. Multiple logistic models were used to assess a stratified relationship between hs-CRP levels and subclinical carotid atherosclerosis. Strata were defined according to glucose metabolic status.

RESULTS

The prevalence of increased IMT and plaques were 27.3% and 21.3%, respectively. The adjusted odds ratios (95% confidence interval) for IMT across hs-CRP quartiles were as follows: 1.00 (reference), 1.10(0.88-1.38), 1.08(0.86-1.35) and 1.32(1.06-1.66) in blood glucose-normal subjects; 1.00 (reference), 1.33(0.92-1.91), 1.33(0.93-1.91), and 1.59(1.10-2.30) in prediabetic subjects; 1.00 (reference), 0.94(0.54-1.62), 1.17(0.65-2.12) and 0.98(0.55-1.76) in diabetic subjects, respectively. Similar results were observed for plaques.

CONCLUSIONS

Our results suggest that inflammatory levels are differently related to subclinical carotid atherosclerosis by the different glucose metabolic status.

The Impact of Age on Clinical Outcomes of Coronary Artery Bypass Grafting: Long-Term Results of a Real-World Registry

The aim of this retrospective multicenter registry study was to investigate age-dependent trends in mortality, long-term survival, and comorbidity over time in patients who underwent isolated CABG from 2003 to 2015. The percentage of patients < 60 years of age was 18.9%. Female sex, chronic pulmonary disease, extracardiac arteriopathy, and neurologic dysfunction disease were significantly less frequent in this younger population. The prevalence of BMI ≥ 30, previous myocardial infarction, preoperative severe depressed left ventricular ejection fraction, and history of previous PCI were significantly higher in this population. After PS matching, at 5 years, patients < 60 years of age reported significantly lower overall mortality (p < 0.0001), cardiac-related mortality (p < 0.0001), incidence of acute myocardial infarction (p = 0.01), and stroke rates (p < 0.0001). Patients < 60 years required repeated revascularization more frequently than older patients (p = 0.05). Patients < 60 who underwent CABG had a lower risk of adverse outcomes than older patients. Patients < 60 have a different clinical pattern of presentation of CAD in comparison with more elderly patients. These issues require focused attention in order to design and improve preventive strategies aiming to reduce the impact of specific cardiovascular risk factors for younger patients, such as diet, lifestyle, and weight control.

Association between diet quality and measures of body adiposity using the Rate Your Plate survey in patients presenting for coronary angiography

BACKGROUND

Diet is a modifiable risk factor for cardiovascular disease; however, dietary patterns are historically difficult to capture in the clinical setting. Healthcare providers need assessment tools that can quickly summarize dietary patterns. Research should evaluate the effectiveness of these tools, such as Rate Your Plate (RYP), in the clinical setting.

HYPOTHESIS

RYP diet quality scores are associated with measures of body adiposity in patients referred for coronary angiography.

METHODS

Patients without a history of coronary revascularization (n = 400) were prospectively approached at a tertiary medical center in New York City prior to coronary angiography. Height, weight, and waist circumference (WC) were measured; body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. Participants completed a 24-question RYP diet survey. An overall score was computed, and participants were divided into high (≥58) and low (≤57) diet quality groups.

RESULTS

Participants in the high diet quality group (n = 98) had significantly lower measures of body adiposity than did those in the low diet quality group (n = 302): BMI (P < 0.001), WC (P = 0.001), WHtR (P = 0.001). There were small but significant inverse correlations between diet score and BMI, WC, and WHtR (P < 0.001). These associations remained significant after adjustment for demographics, tobacco use, and socioeconomic factors.

CONCLUSIONS

Higher diet quality scores are associated with lower measures of body adiposity. RYP is a potential instrument to capture diet quality in a high-volume clinical setting. Further research should evaluate the utility of RYP in cardiovascular risk-factor control.

The protective effects of a novel fitness-fatness index on all-cause mortality among adults with cardiovascular disease

BACKGROUND

We evaluated the specific association between a fitness-fatness index (FFI) and all-cause mortality among a national sample of US adults with coronary artery disease, congestive heart failure, or myocardial infarction. This FFI has recently emerged in the literature as a novel index of health.

HYPOTHESIS

We hypothesize that FFI will be inversely associated with mortality risk.

METHODS

The FFI was calculated as cardiorespiratory fitness divided by waist-to-height ratio. Data from the 1999-2006 National Health and Nutrition Examination Survey were used to identify 1206 participants, ages 20 to 85. Person-months of follow-up were calculated from the date of interview until date of death or censoring on December 31, 2011, whichever came first.

RESULTS

In a Cox proportional hazards model, for every 1-FFI-unit increase, participants had a 6% reduced all-cause mortality rate (hazard ratio [HR]: 0.94, 95% confidence interval [CI]: 0.91-0.97, P = 0.001; N = 1206). Results were similar among those diagnosed with coronary artery disease (HR: 0.94, 95% CI: 0.90-0.98, P = 0.007), congestive heart failure (HR: 0.95, 95% CI: 0.91-0.99, P = 0.02), or myocardial infarction (HR: 0.96, 95% CI: 0.92-0.99, P = 0.04). When examined in isolation, only fitness (and not fatness) was linked with survival benefits.

CONCLUSIONS

In this national sample, increased FFI was associated with reduced risk of all-cause mortality; this association was driven by the beneficial effects of fitness. This underscores the importance of tailored cardiac rehabilitation programs designed to promote fitness, in particular, among cardiac populations.

Association Between Body Mass Index and Age of Presentation With Symptomatic Coronary Artery Disease

BACKGROUND

Obesity is increasingly recognized as an important risk factor for coronary artery disease (CAD).

HYPOTHESIS

Patients with increased body mass index (BMI) present at a younger age with symptomatic CAD.

METHODS

We analyzed data on 2137 consecutive patients admitted for treatment of CAD proven on angiography from 2010 to 2013, excluding those with prior coronary intervention or bypass surgery.

RESULTS

Mean age was 64.1 ± 12.4 years; 75% were male; 43.6% were overweight (BMI 25-29.9 kg/m² ) and 31.6% were obese (BMI ≥30 kg/m² ). Patients with BMI ≥25 kg/m² compared with <25 kg/m² were more likely to have diabetes (24.5% vs 13.6%), hypertension (56.2% vs 45.5%), and hyperlipidemia (42.4% vs 31.6%; P < 0.0001 for all). On multivariate analysis adjusted for sex and cardiovascular risk factors, patients in higher BMI categories had lower mean age in a linear and stepwise fashion compared with those with normal BMI (P < 0.0001). For example, compared with patients with normal BMI, those with BMI of 35 to 39.9 kg/m² were on average 9.2 years younger (P < 0.0001). Multivariate analysis examining the interaction between sex and BMI produced similar results for effect of BMI on age of presentation (P = 0.97 for interaction).

CONCLUSIONS

After multivariate adjustment, patients with increased BMI presented at an earlier age with symptomatic CAD compared with patients with normal BMI. Primary prevention efforts in those with increased BMI to reduce risk-factor burden, including evidence-based treatments for weight reduction, promise to reduce risk or delay onset of CAD.