Obesity, body fat distribution and coronary atherosclerosis among Japanese men and women

The association between body mass index and coronary artery disease severity: a comparison of black and white patients

INTRODUCTION

Despite known associations between obesity and cardiovascular disease, the relationship between obesity as reflected by body mass index (BMI) and angiographic coronary artery disease (CAD) is not fully understood. Moreover, this relationship has not been adequately defined in black patients, a group demonstrated to have lower rates of angiographic CAD despite higher rates of CAD risk factors, cardiovascular events, and CAD-related mortality.

METHODS

Using an angiography database from an academic hospital, we studied patients undergoing first-time, nonemergent coronary angiography. From this cohort, we selected those without previous CAD diagnosis and with complete anthropomorphic measures and outcome data. Using models that controlled for patient demographics and CAD risk factors, we compared rates of angiographic CAD for blacks and whites by BMI.

RESULTS

Black patients had higher rates of CAD risk factors, including obesity and morbid obesity. Nevertheless, black patients were less likely to have a significant stenosis than white patients. Morbid obesity was associated with significantly less CAD in both race groups. Controlling for black-white differences in BMI and the prevalence of morbid obesity did not change the odds ratio for CAD among black patients.

CONCLUSIONS

Racial differences in BMI and prevalence of morbid obesity do not contribute to black-white differences in CAD detected during elective angiography. The paradoxical association of morbid obesity with a lower burden of atherosclerosis may be attributed in part to the limitations of noninvasive screening in the morbidly obese and subsequent referral of patients without disease for angiography.

Central obesity and coronary heart disease risk factors in referral outpatients to zahedan cardiology clinic, iran

BACKGROUND

Coronary Heart Disease (CHD) is one of the most common and life-threatening diseases in both developed and developing countries and a close correlation has been found between different types of obesity and CHD.

OBJECTIVES

The current study investigated the relationship between central obesity and coronary heart disease risk factors in CHD referral outpatients to Khatam Clinic, Zahedan, Iran.

PATIENTS AND METHODS

In this clinical, cross-sectional study, data for 120 CHD patients aged 30-60 years were included. Based on waist-to-hip ratio (WHR), subjects were classified into two groups: not centrally obese (NCO; WHR ≤ 0.95 for men, ≤ 0.8 for women) and centrally obese (CO; WHR > 0.95 and > 0.8 for men and women, respectively). Triglyceride (TG), total cholesterol (TC), blood urea nitrogen, creatinine, and fasting blood sugar (FBS) were enzymatically determined. Sitting systolic and diastolic blood pressures were measured for each patient.

RESULTS

Significantly more women than men and significantly more subjects with less education than subjects with more education were CO. Rates of CO were higher in subjects 45-60 years old than in those 30-45 years old (n.s.). CO subjects also had higher mean systolic and diastolic blood pressure, TG, and creatinine levels (n.s.). Significantly higher mean values were observed for FBS in CO subjects than in NCO subjects (P = 0.02). Mean values for smoking were significantly higher in the NCO group compared with the CO group (P = 0.004).

CONCLUSIONS

According to the results of this study, in CHD patients, central obesity was associated with certain risk factors, especially FBS. Central obesity was more evident in women, less educated subjects, and older subjects. Further research is required to clarify these associations.

The effect of the cardiac rehabilitation program on obese and non-obese females with coronary heart disease

INTRODUCTION

Obesity is strongly associated with coronary heart disease and it is known as an independent risk factor. So, the aim of this study was to investigate the effects of phase II comprehensive cardiac rehabilitation program on obesity indexes, functional capacity, lipid profiles, and fasting blood sugar in obese and non-obese female patients with coronary heart disease and to compare changes in these groups.

MATERIALS AND METHODS

Two hundred and five women with coronary heart disease participated in our study. At the beginning of study, body mass index, functional capacity, and lipid profiles and fasting blood sugar were evaluated; then, these patients were divided into two groups, patients who had BMI≥30 were known as obese and who had BMI<30 were known as non-obese patients. All of them completed the period of cardiac rehabilitation program, and 2 months later, all risk factors were examined for the second time in each group. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes, independent t-tests and paired t-tests were used.

RESULTS

Data revealed that unless in weight (P=0.00) and functional capacity (P=0.001), there were no significant differences in obese and non-obese female patients, at baseline. As a result of the cardiac rehabilitation program, both groups had significant improvement in functional capacity (P=0.00), weight reduction (P=0.00), triglyceride (P=0.01 and P=0.02, respectively), low-density lipoprotein cholesterol (P=0.01), and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (P=0.00 and P=0.003, respectively). As well, significant improvement was observed in high-density lipoprotein (P=0.01) only in obese female, and non-obese female had significant differences in total cholesterol (P=0.003). However, there were not significant changes in total cholesterol (P=0.05) and fasting blood sugar (P=0.09) in obese female. Also, non-obese females didn't have favorable differences in high-density lipoprotein cholesterol (P=0.23) and fasting blood sugar (P=0.13). In addition, comparing two groups didn't show any significant differences in each risk factors except BMI (P=0.03).

CONCLUSION

Our study revealed that comprehensive cardiac rehabilitation program results in significant improvement in cardiovascular risk factors and functional capacity at all levels of BMI in female with coronary heart disease.

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

BACKGROUND AND AIM

To estimate if a meaningful relationship exists between body mass index (BMI) and the entity of coronary atherosclerosis, coronary events and mortality in a cohort of consecutive patients with suspected coronary artery disease (CAD).

METHODS AND RESULTS

In this prospective study, we enrolled 1299 consecutive patients (905 [69.7%] males) who had undergone coronary angiography. Our sample consisted of 477 patients (36.8%) of normal weight; 567 (43.6%) overweight and 255 (19.6%) obese, according to the WHO classification. Conventional cardiovascular risk factors, BMI, endothelial function and subclinical inflammation were studied. Different angiographic CAD scores were used to quantify coronary atherosclerotic burden. In overweight and obese patients, respect to normal weight population, there is a higher prevalence of hypertension, hypercholesterolemia and diabetes mellitus, but BMI was not significantly associated with greater extent of coronary atherosclerosis. At follow-up (mean: 40; range: 24-82 months) obese and overweight patients showed a higher incidence of coronary events compared to the normal weight population (74.9% [obese] versus 62.7% [overweight] versus 53.2% [normal weight]; adjusted relative risk [obese versus overweight]: 1.08 [95% confidence interval: 1.02-1.23]; P<0.05; and adjusted RR [obese versus normal weight]: 1.17 [95% CI: 1.10-1.42], P<0.01). Mortality from cardiac events was not significant within the categories. The Cox regression model showed flow mediated dilation (P<0.0001), high-sensitive C reactive protein (P=0.022) and BMI (P=0.045) as independent predictors of acute coronary events.

CONCLUSION

BMI is not associated with the extent of coronary atherosclerosis and mortality. The higher incidence of coronary events in obese subjects is only partly explained by conventional associated risk factors. Impaired endothelial function and sub-clinical inflammation could be involved in this association but BMI itself is related to cardiovascular events suggesting that other unknown (or not considered) pathways are involved.

Association of cardiomegaly with coronary artery histopathology and its relationship to atheroma

AIMS

Hypertrophied hearts at autopsy often display excessive coronary artery atherosclerosis, but the histopathology of coronary arteries in hearts with and without cardiomegaly has rarely been compared.

METHODS

In this study, forensic autopsies provided hearts with unexplained enlargement plus comparison specimens. Right coronary artery was opened longitudinally and flattened for formalin fixation and H&E-stained paraffin sections were cut perpendicular to the endothelial surface. The micro-scopically observed presence or absence of a necrotic atheroma in the specimen was recorded. At multiple sites far removed from any form of atherosclerosis, measurements were taken of intimal thickness, numbers of smooth muscle cells (SMC) and their ratio, the thickness per SMC, averaged over the entire nonatheromatous arterial length. When the mean thickness per SMC exceeded a certain cutoff point, the artery was declared likely to contain a necrotic atheroma.

RESULTS

The prevalence of specimens with necrotic atheromas increased stepwise with increasing heart weight, equally with fatal or with incidental cardiomegaly, and equally with hypertension- or obesity-related hypertrophy, rejecting further inclusion of appreciable age, race, or gender effects. The prevalence of specimens with thickness per SMC exceeding the cutoff point was almost always nearly identical to the prevalence of observed necrotic atheroma, showing the two variables to be tightly linked to each other with quantitative consistency across group comparisons of every form.

CONCLUSIONS

In summary, cardiomegaly, irrespective of the specific cause, seems to accelerate the risk of atheromas, and to do so by first altering the arterial architecture, especially by increasing intimal thickness per SMC.

Association between white blood cell count and components of metabolic syndrome

BACKGROUND

Components of metabolic syndrome (MetS) were found to be associated with several inflammatory factors including white blood cell count (WBCC), which is an easily available test in clinical practice. In the present study, the relationships between WBCC and MetS components were investigated in children.

METHODS

A total of 288 Taiwanese children, under 10 years old, with normal WBCC, were enrolled in the study. They were divided into quartiles according to WBCC (lowest, WBCC1; highest, WBCC4). The mean values of each MetS component for every group were compared in boys and girls separately. Multivariate linear regression between the WBCC and the MetS components after adjusting for age and body mass index (BMI) were also evaluated.

RESULTS

In group comparison, only the high-density lipoprotein-cholesterol (HDL-C) was found to be significantly lower in WBCC4 in boys. Other components were not different. After multivariate linear regression, WBCC was negatively correlated to HDL-C and positively to BMI in boys. Although not significant, similar relationships were also observed in girls. Interestingly, borderline positive correlation was noted between triglyceride (TG) and WBCC in girls.

CONCLUSION

BMI was positively and HDL-C was negatively related to WBCC in boys. A similar trend could also be observed in girls but without significance. Borderline significant correlation between TG and WBCC was noted in girls. These findings suggest that cardiovascular risks might commence even in childhood. Early detection of children with these abnormalities may help to prevent cardiovascular disease and diabetes in adolescence or even adulthood.

Visceral fat amount is associated with carotid atherosclerosis even in type 2 diabetic men with a normal waist circumference

OBJECTIVE

Our objective was to investigate whether determination of the quantity of visceral fat has an additional benefit in assessing atherosclerotic burden in men with type 2 diabetes compared with the traditional measurement of waist circumference (WC) alone.

METHODS

This was an observational study performed in 368 men with type 2 diabetes, consecutively enrolled in Diabetes Clinics. Common carotid artery far-wall intima-media thickness (IMT), WC and visceral fat thickness (VFT), as measured by ultrasonography, were measured for each subject. Abdominal and visceral obesity were defined as a WC >90 cm and a VFT > or =47.6 mm, respectively.

RESULTS

Among subjects with abdominal obesity (n=174), 35 subjects did not have visceral obesity. In contrast, among the subjects without abdominal obesity (n=194), 88 patients had visceral obesity. Despite no differences in age, glucose control, lipid profile and treatment modalities, there was a significant difference in carotid IMT based on VFT strata, but not WC strata. The subjects without abdominal obesity, but who had visceral obesity, had a higher carotid IMT compared with subjects with abdominal obesity, but without visceral obesity (maximal, 0.94+/-0.35 vs 0.78+/-0.17 mm; and average, 0.74+/-0.19 vs 0.64+/-0.14 mm, respectively, P<0.001).

CONCLUSIONS

Subjects having visceral obesity, regardless of a normal WC, showed a higher carotid IMT compared with those with increased WC, but less visceral fat. In addition to WC, a direct estimation for visceral fat may provide an additional role in assessing atherosclerotic burden in men with type 2 diabetes.

Truncal fat determined by dual-energy X-ray absorptiometry is an independent predictor of coronary artery disease extension

BACKGROUND

Controversy prevails regarding the existence of a correlation between the severity of coronary artery disease (CAD) and the extent and distribution of obesity.

PURPOSE

To assess the correlation between total fat, truncal fat (TF), and lean mass, obtained with dual-energy X-ray absorptiometry (DEXA) and standard anthropomorphic indices (body mass index, waist circumference, waist-to-hip ratio) and to verify whether DEXA indices can predict the extent and severity of CAD.

MATERIALS AND METHODS

Fifty-eight patients (19 females) consecutively referred for coronary angiography underwent physical examination and DEXA assessment of body composition.

RESULTS

Of the 58 patients enrolled, 22 were overweight and 13 were obese. Significant CAD was found in 39 (67%) patients. DEXA-derived total mass and fat mass enabled us to distinguish overweight from obese patients (P<0.005), whereas just TF mass correlated with the number of diseased vessels after adjusting for body mass index, sex, age, and smoking habit (odds ratio, 8.68; 95% confidence interval: 1.02-74.10).

CONCLUSION

TF determined by DEXA is independently related with CAD extension.

Determination of the Leading Central Obesity Index among Cardiovascular Risk Factors in Iranian Women

Background

It is unknown whether the waist circumference (WC) or the waist-to-hip ratio (WHR) is a better predictor of cardiovascular risk factors at different ages.

Objective

To compare WC and WHR as predictors of cardiovascular risk factors and to determine the prevalence of some cardiovascular risk factors in overweight and obese adult women at different ages.

Methods

In this clinical cross-sectional study, 714 overweight and obese women aged 20 to 70 years who were referred to two nutrition clinics in Sistan and Baluchestan province, Islamic Republic of Iran, were studied. The subjects were classified into three groups, 20 to < 35, 35 to < 50, and > or = 50 years of age. Anthropometric indices were measured according to the standard protocol. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and TC/HDL-C ratios were enzymatically determined.

Results

Older subjects (> or = 50 years old) had significantly higher values of body mass index (BMI), WC, TC, TG, and LDL-C than those in the two younger age classes. The prevalence rates of obesity, high WC, high WHR, high TC, high TG, high LDL-C, and high TC/HDL-C ratios were higher in the older subjects. After adjustment for age and BMI, multiple linear regression showed that WC was significantly related to TC and TG in the 20- to < 35-year-old group and to TG in the 35- to < 50-year-old group. In the older participants, WHR was significantly related to TG.

Conclusions

The prevalence of cardiovascular risk factors increases with age. In clinical practice, WC is a better index for predicting some cardiovascular risk factors in younger and middle-aged women; however, for older women, WHR is better.

Association of obesity and visceral fat distribution with intima-media thickness of carotid arteries in middle-aged and older persons

OBJECTIVE

The association between obesity and atherosclerotic disease is controversial. We examined whether common carotid intima-media thickness (IMT), a precursor to preclinical atherosclerosis, was associated with total body fatness or the accumulation of fat mass in the abdominal region in middle-aged and older persons.

METHODS

Participants were consecutively enrolled from patients aged >or=50 years, and were 623 men aged 73+/-10 (mean+/-standard deviation) years and 835 women aged 76+/-10 years. Demographic data were collected and maximal preperitoneal fat thickness (PFT(max)) and carotid intima-media thickness (IMT) were evaluated on B-mode ultrasonography. Subjects were divided into 3 groups on the basis of body mass index (BMI), a marker of general obesity.

RESULTS

It was shown by multiple regression analysis for IMT that age, smoking status, hypertension and uric acid were significantly associated with IMT in subjects in the lowest BMI group (<20 kg/m(2)), and age, hypertension, dyslipidemia and uric acid in middle BMI group (20-22.9 kg/m(2)). Moreover, man sex, age, BMI, PFT(max), smoking status, hypertension and uric acid were significantly associated with IMT in subjects with highest BMI group (>or=23 kg/m(2)). Analysis of covariance showed that interaction between BMI and visceral obesity (f=7.202, p=0.007) was significantly associated with IMT, in addition to age, visceral obesity, smoking status, hypertension, dyslipidemia and uric acid.

CONCLUSION

The present study indicates a graded and independent association between general and visceral obesity and preclinical carotid artery changes in patients aged >or=50 years with a BMI >or=23 kg/m(2).

Visceral adipose tissue, a potential risk factor for carotid atherosclerosis: results of the Multicultural Community Health Assessment Trial (M-CHAT)

BACKGROUND AND PURPOSE

The association between abdominal obesity and atherosclerosis is believed to be due to excess visceral adipose tissue (VAT), which is associated with traditional risk factors. We hypothesized that VAT is an independent risk factor for atherosclerosis.

METHODS

Healthy men and women (N=794) matched for ethnicity (aboriginal, Chinese, European, and South Asian) and body mass index range (<25, 25 to 29.9, or > or =30 kg/m(2)) were assessed for VAT (by computed tomography scan), carotid atherosclerosis (by ultrasound), total body fat, cardiovascular risk factors, lifestyle, and demographics.

RESULTS

VAT was associated with carotid intima-media thickness (IMT), plaque area, and total area (IMT area and plaque area combined) after adjusting for demographics, family history, smoking, and percent body fat in men and women. In men, VAT was associated with IMT and total area after adjusting for insulin, glucose, homocysteine, blood pressure, and lipids. This association remained significant with IMT after further adjustment for either waist circumference or the waist-to-hip ratio. In women, VAT was no longer associated with IMT or total area after adjusting for risk factors.

CONCLUSIONS

VAT is the primary region of adiposity associated with atherosclerosis and likely represents an additional risk factor for carotid atherosclerosis in men. Most but not all of this risk can be reflected clinically by either the waist circumference or waist-hip ratio measures.

ACDC/adiponectin and PPAR-gamma gene polymorphisms: implications for features of obesity

OBJECTIVE

The main purpose of this study was to investigate associations of single-nucleotide polymorphisms (SNPs) in the adipocyte C1q and collagen domain-containing (ACDC) gene and its regulator, the nuclear peroxisome proliferator-activated receptor (PPAR)-gamma gene, with body fat mass and its topographical distribution in postmenopausal women.

RESEARCH METHODS AND PROCEDURES

Participants were 1501 healthy women, 60 to 85 years old, who were genotyped for four SNPs in the ACDC gene (-11391G/A, -11377C/G, +45T/G, +276G/T) and the Pro12Ala SNP in the PPAR-gamma gene. Total body fat mass and the central to peripheral fat mass ratio (CFM/PFM ratio) were measured using DXA. Adiponectin and homeostasis model assessment of insulin resistance were measured in 287 subjects.

RESULTS

The -11377C/G SNP was associated with adiponectin (p < 0.001) and the CFM/PFM ratio (p = 0.005); the G allele being associated with low adiponectin and high CFM/PFM ratio. Similar associations of adiponectin (p = 0.0001) and the CFM/PFM ratio (p = 0.002) characterized the 1_2 (G_G) promoter haplotype (11391G/A_-11377C/G). Genotype variation of SNP Pro12Ala was associated with total body fat mass (p = 0.04); women with GG being the most obese (p = 0.01). The Ala/Ala (GG) genotype of Pro12Ala SNP interacted with the CC genotype of SNP-11377C/G in the determination of BMI (p = 0.001), when analyzed using a codominant model.

DISCUSSION

Polymorphisms in the ACDC gene are associated with body fat distribution, whereas the Pro12Ala polymorphism in PPAR-gamma is associated with overall adiposity, apparently in interaction with an ACDC promoter SNP.

Waist circumference and waist-to-hip ratio as predictors of serum concentration of lipids in Brazilian men

OBJECTIVE

It is unknown whether waist circumference can predict a lipid profile beyond that predicted by body fatness alone, after adjustment for important confounding variables such as smoking, alcohol intake, and physical activity. The purpose of this non-clinical, healthy-subject study was to test this hypothesis.

METHODS

Data refer to 416 men, ages 20 to 58 y with a body mass index between 18.5 and 29.9 kg/m(2), who were blood donors living in a Brazilian city. Alcohol consumption, smoking, and physical activity were evaluated by interview; body fat was measured by electrical bioimpedance, and weight, height, and waist and hip circumferences were measured by trained anthropometrists. Multiple linear regression analysis was performed to quantify the association between measurements of fat distribution (waist circumference and waist-to-hip ratio) and the ratio of total cholesterol to high-density lipoprotein cholesterol and triacylglycerols independently of measurements of fatness and potentially confounding factors.

RESULTS

Waist circumference was strongly correlated with percentage of body fat (r = 0.90), whereas waist-to-hip ratio was less correlated (r = 0.55). After adjustment for age, percentage of body fat, smoking, alcohol intake, and physical activity, waist circumference was not significantly related to the ratio of total cholesterol high-density lipoprotein cholesterol, whereas the waist-to-hip ratio was strongly associated among the youngest subjects (beta = 3.51, P = 0.005).

CONCLUSION

Although several studies have analyzed the association between serum lipids with anthropometric markers, few, including the present one, support waist circumference as a good predictor of lipid profile.

Independent predictors of the severity of angiographic coronary atherosclerosis: the lack of association between impaired glucose tolerance and stenosis severity

Independent predictors of the severity of coronary atherosclerosis are ill defined. We sought to determine the predictors and examine the association of impaired glucose tolerance with stenosis severity. Four hundred thirty-seven patients were studied who underwent coronary angiography for suspected coronary artery disease. Serum concentrations of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDLc), lipoprotein(a) [Lp(a)] and apolipoproteins (Apo A-I and Apo B) were measured and low-density lipoprotein cholesterol (LDLc) concentration was calculated. Except the patients treated for diabetes mellitus (DM), patients were classified into three groups such as normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and DM by glucose tolerance test. Coronary atherosclerosis index (CAI) representing the severity of coronary atherosclerosis was determined by summation of the stenosis score of all lesions on coronary angiograms. Results indicated that age, total amount of cigarettes smoked, Apo B/Apo A-I, and LDLc/HDLc correlated with CAI, whereas HDLc and Apo A-I concentrations inversely correlated with CAI. TC, TG, Lp(a), LDLc, Apo B concentrations and body mass index did not correlate with CAI. One- and two-hour plasma glucose concentrations and the area of plasma glucose concentration under the curve at the glucose tolerance test did not correlate with CAI, revealing that post-challenge glycemia is not associated with stenosis severity. CAI in IGT patients was significantly lower than that in DM patients but did not differ from that in NGT patients, indicating that IGT does not affect the stenosis severity. Multivariate analysis showed that age, male gender, Apo B/Apo A-I, DM, systemic hypertension, and total amount of cigarettes smoked were independent predictors of CAI.

Obesity, body fat and coronary atherosclerosis

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 (> or =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.

Analysis of the relationship between total cholesterol, age, body mass index among males and females in the WHO MONICA Project

OBJECTIVE

To explore the relationship between hypercholesterolaemia, age and BMI among females and males.

DESIGN

Population-based cross-sectional survey.

SUBJECTS

The data came from the initial surveys of the WHO MONICA Project. In all, 27 populations with 48 283 subjects (24 017 males and 24 266 females) aged 25-64 y were used for the analysis.

MEASUREMENTS

Total cholesterol, weight, height, BMI, prevalence of hypercholesterolaemia (PHC) defined as cholesterol >/=6.5 mmol/l, and the prevalence of obesity (POB) defined as BMI >/=30 kg/m(2).

RESULTS

PHC increased with age, with PHC in males being significantly higher than in females at age range 25-49 y and significantly lower than in females at age range 50-64 y. Age-related increase in hypercholesterolaemia was steeper in females than in males. There was a statistically significant positive association between hypercholesterolaemia and BMI. Multiple logistic regression analysis revealed a negative statistically significant (P<0.001) effect modification involving age and BMI on the risk of having hypercholesterolaemia both in females and males. The relation between PHC and BMI became weaker in higher age groups, with no statistically significant association in females aged 50-64 y.

CONCLUSION

Public health measures should be directed at the prevention of obesity in young adults since the strongest effect of obesity on the risk of hypercholesterolaemia has been found in subjects aged 25-39 y.

Past history of obesity (overweight by WHO criteria) is associated with an increased risk of nonfatal acute myocardial infarction: a case-control study in Japan

BACKGROUND

Obesity is an important risk factor for the occurrence of coronary artery disease (CAD) in Western countries and furthermore, it often coexists with other CAD risk factors such as hypertension, dyslipidemia and diabetes mellitus. However, it is uncertain whether obesity is a CAD risk factor in Japan because Japanese are relatively thin on average.

METHODS AND RESULTS

The CAD risk associated with obesity (body mass index > or =25.0) 10 years before as well as at the time of the survey was assessed in a case - control study of acute myocardial infarction (AMI), which compared 660 AMI patients aged 40-79 years and 1,277 community controls, matched to each case by sex, year of birth, and residence. The prevalence of current obesity did not show any material difference between cases and controls, but compared with controls, past obesity was much more frequent in cases. Even after controlling for other CAD risk factors, past obesity was associated with a 2-fold increase in the risk of AMI. Past obesity was associated with an increased risk of AMI even without current obesity.

CONCLUSION

Past obesity is a CAD risk, even after weight reduction.

Role of prehypertension in the development of coronary atherosclerosis in Japan

BACKGROUND

Hypertension is an important risk factor of coronary heart disease. A new guidelines for hypertension prevention and management in The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in the United States recommended lifestyle modification or medical treatment for subjects with prehypertension. However, whether prehypertension increases the risk of coronary atherosclerosis in the Japanese population is still unknown.

METHODS

A cross-sectional study in a clinical setting was conducted. The subjects were 705 patients (417 males and 288 females) aged 30 years and older who underwent a first-time coronary angiography for suspected or known coronary heart disease at 5 major cardiology departments in the Fukuoka metropolitan area between September 1996 and August 1997.

RESULTS

Compared to subjects with normal blood pressure, those with prehypertension had an increased risk of coronary atherosclerosis even after adjusting for other factors.

CONCLUSION

Prehypertension may be an important clinical entity which requires treatment in the Japanese population.

Peripheral adiposity exhibits an independent dominant antiatherogenic effect in elderly women

BACKGROUND

Although several lines of evidence point to an atherogenic role of central fat mass (CFM), few data are available to address the specific role played by peripheral fat mass (PFM).

METHODS AND RESULTS

This study was a cross-sectional analysis of 1356 women aged 60 to 85 years. Study variables were physical measures, CFM and PFM measured by DEXA, aortic calcification (AC) graded on lateral radiographs, lipid and glucose metabolites, blood pressure, and information on lifestyle factors and coronary disease. Peripheral fat mass showed independent negative correlation with both atherogenic metabolic risk factors and AC (P<0.001). The most severe insulin resistance-dyslipidemic syndrome and AC (score 5.10+/-0.76) was found in women with high central fat percentage (CF%, 21.7+/-0.2%) and low peripheral fat percentage (PF%, 18.3+/-0.2%, n=48). The least severe AC (score 2.45+/-0.31) was found in obese women with high CF% (21.6+/-0.1%) and high PF% (27.3+/-0.14%, n=112). The insulin resistance-dyslipidemic syndrome was also less severe compared with those with the same CF% but low PF%. The most favorable metabolic profile characterized women with low CF% (11.56+/-0.16%) and high PF% (26.86+/-0.33%, n=44). In women with a history of myocardial infarct (18.41+/-0.55%, n=45), CF% was significantly higher compared with women with no manifest coronary disease (16.48+/-0.12%, n=1210) without differences in PF%.

CONCLUSIONS

In elderly women, localization of fat mass is apparently more important for atherosclerosis than obesity per se; although CFM is associated with atherogenic tendencies, PFM seems to exhibit an independent dominant antiatherogenic effect.

Relation between type A behavior pattern and the extent of coronary atherosclerosis in Japanese women

This study examined the relation of Type A behavior pattern and its components to angiographically documented coronary atherosclerosis in 198 Japanese women. A questionnaire-based interview elicited psychosocial and other factors. Type A behavior pattern was measured by 12 questions. Significant coronary stenosis was defined when a 75% or greater luminal narrowing occurred at one or more major coronary arteries or 50% or greater narrowing occurred at the left main artery. Gensini's score also was calculated. Logistic regression analysis was used to calculate odds ratios and 95% confidence intervals with adjustment for traditional coronary risk factors and the presence of a job. Global Type A behavior pattern showed no material association with the severity of coronary atherosclerosis assessed by both Gensini's score and the presence of significant coronary stenosis. However, its subcomponents, enthusiasm and competitiveness, were positively related to the severity of coronary atherosclerosis, whereas self-confidence and perfectionism were negatively related. These findings suggest overall a null association between global Type A and coronary atherosclerosis as well as the presence of toxic or beneficial components of Type A behaviors in Japanese women.