The Relationship between Body Mass Index and the Severity of Coronary Artery Disease in Patients Referred for Coronary Angiography

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.

The relationship of circulating neuregulin 4 and irisin, and traditional and novel cardiometabolic risk factors with the risk and severity of coronary artery disease

BACKGROUND AND AIMS

Neuregulin 4 (NRG4) and irisin are adipokines that have been suggested to be associated with cardiometabolic risk factors and coronary artery disease (CAD), but the data are inconclusive. This study aimed to investigate the relationship between circulating NRG4 and irisin and cardiometabolic risk factors with CAD risk and severity.

METHODS AND RESULTS

In this cross-sectional study, the presence of CAD and the severity of stenosis (gensini score) were documented based on coronary angiography in 166 adults. Circulating NRG4 and irisin, glucose homeostasis markers, hs-CRP, lipid profiles, blood pressure, and anthropometric measurements were assessed as well. Age (p = 0.005), sex (p = 0.008), SBP (p = 0.033), DBP (p = 0.04), MAP (p = 0.018), FBG (p = 0.012), insulin (p = 0.039) and HOMA-IR (p = 0.01) were significantly associated with odds of having CAD. The final logistic regression model showed that age, sex, HOMA-IR, and MAP were the most important determinants of having CAD. There were no significant associations between circulating irisin and NRG4 with odds of having CAD. The final general linear model showed that being men (β = 17.303, 95% CI: 7.086-27.52, P = 0.001), age (Aβ = 0.712, 95% CI: 0.21-1.214, P = 0.006), HOMA-IR (Aβ = 2.168, 95% CI: 0.256 to 4.079, P = 0.027), and NRG4 level (β = 1.836, 95% CI: 0.119-3.553, P = 0.036) were directly associated with higher gensini score. Participants with the three-vessel disease had a mean increase of about 5 units in circulating irisin compared to those with no clinical CAD (β = 5.221, 95% CI: 0.454-9.987, p = 0.032).

CONCLUSIONS

This study showed that the adipokines NRG4 and Irisin might be associated with the severity of coronary stenosis.

Sex Differences in the Relationship between Abdominal Obesity and Cardiovascular Death in Elderly Patients with Permanent Pacemakers Implantation: A Retrospective Cohort Study

Objectives

This study aims to investigate the association between waist circumference (WC) and cardiovascular death in patients with permanent pacemakers (PPMs).

Methods

This is a retrospective cohort study that enrolled patients who underwent PPM implantation in Fuwai Hospital from May 2010 to April 2014, according to the BIOTRONIK Home Monitoring database. The WC was treated as sex-specific quartiles, and patients were divided into three groups according to body mass index (BMI): normal (≤22.9 kg/m2), overweight (23-24.9 kg/m2), and obese (≥25 kg/m2). Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for cardiovascular death according to WC and BMI in patients.

Results

492 patients with PPMs implantation were analyzed (mean age: 71.9 ± 10.8 years; 55.1% men (n = 271)). Data showed that after a mean follow-up 67.2 ± 17.5 months, 24 (4.9%) patients had experienced cardiovascular death and 71 (14.4%) were cases of all-cause mortality. Men in the third quartile of WC had an HR of 10.67 (Model 4, 95% CI: 1.00-115.21, p trend = 0.04) for cardiovascular death. However, the association disappeared in female patients (Model 4, HR = 3.99, 95% CI: 0.37-42.87, p trend = 0.25). There was no association between BMI and cardiovascular death or all-cause mortality in both male and female patients.

Conclusions

Abdominal obesity was associated with an increased risk of cardiovascular death in patients with PPMs, and this relationship was only in male patients.

The role of traditional obesity parameters in predicting the number of stenosed coronary arteries (≥ 60%) among patients undergoing cardiac catheterization

The correlation between obesity and coronary artery disease (CAD) has been well-documented in the literature. Body mass index, waist–height ratio, waist–hip ratio, body adiposity index, body shape index, waist circumference, and hip circumference are traditional obesity parameters used to measure obesity. This study aimed to investigate the role of these traditional obesity parameters in the prediction of the number of stenosed coronary arteries (≥ 60%) among patients undergoing cardiac catheterization. A descriptive cross-sectional study was conducted among 220 hospitalized patients undergoing cardiac catheterization in two hospitals in Jordan. Bivariate Pearson’s correlation and forward linear regression analysis were used in the current study. Hip circumference was identified as being the best predictor of CAD (r = 0.5), with the best cut-off value of 103 cm (sensitivity = 0.92, specificity = 0.58). Hip circumference had significant regression levels with the number of stented coronary arteries (P = 0.002) and the number of severe stenosed coronary arteries (P = 0.04). The second-best obesity parameter in predicting CAD was waist circumference (r = 0.4), with a cut-off value of 0.95 m (sensitivity = 0.76, specificity = 0.68). High-sensitivity C-reactive protein (HS-CRP), triglycerides, and smoking had significant positive correlations with the number of stented coronary arteries (P < 0.05). Hip circumference of ≥ 103 cm, increased serum level of triglycerides, HS-CRP, and being a smoker are all factors which can predict CAD or the risk of developing it.

Visceral Adiposity in Relation to Body Adiposity and Nutritional Status in Elderly Patients with Stable Coronary Artery Disease

Introduction: The accumulation of visceral abdominal tissue (VAT) seems to be a hallmark feature of abdominal obesity and substantially contributes to metabolic abnormalities. There are numerous factors that make the body-mass index (BMI) a suboptimal measure of adiposity. The visceral adiposity index (VAI) may be considered a simple surrogate marker of visceral adipose tissue dysfunction. However, the evidence comparing general to visceral adiposity in CAD is scarce. Therefore, we have set out to investigate visceral adiposity in relation to general adiposity in patients with stable CAD. Material and methods: A total of 204 patients with stable CAD hospitalized in the Department of Medicine and the Department of Geriatrics entered the study. Based on the VAI-defined adipose tissue dysfunction (ATD) types, the study population (N = 204) was divided into four groups: (1) no ATD (N = 66), (2) mild ATD (N = 50), (3) moderate ATD (N = 48), and (4) severe ATD (N = 40). Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. Results: Patients with moderate and severe ATD were the youngest (median 67 years), yet their metabolic age was the oldest (median 80 and 84 years, respectively). CONUT scores were similar across all four study groups. The VAI had only a modest positive correlation with BMI (r = 0.59 p < 0.01) and body adiposity index (BAI) (r = 0.40 p < 0.01). There was no correlation between VAI and CONUT scores. There was high variability in the distribution of BMI-defined weight categories across all four types of ATD. A total of 75% of patients with normal nutritional status had some form of ATD, and one-third of patients with moderate or severe malnutrition did not have any ATD (p = 0.008). In contrast, 55-60% of patients with mild, moderate, or severe ATD had normal nutritional status (p = 0.008). ROC analysis demonstrated that BMI and BAI have poor predictive value in determining no ATD. Both BMI (AUC 0.78 p < 0.0001) and BAI (AUC 0.66 p = 0.003) had strong predictive value for determining severe ATD (the difference between AUC 0.12 being p = 0.0002). However, BMI predicted mild ATD and severe ATD better than BAI. Conclusions: ATD and malnutrition were common in patients with CAD. Notably, this study has shown a high rate of misclassification of visceral ATD via BMI and BAI. In addition, we demonstrated that the majority of patients with normal nutritional status had some form of ATD and as much as one-third of patients with moderate or severe malnutrition did not have any ATD. These findings have important clinical ramifications for everyday practice regarding the line between health and disease in the context of malnutrition in terms of body composition and visceral ATD, which are significant for developing an accurate definition of the standards for the intensity of clinical interventions.

Mean BMI, visit-to-visit BMI variability and BMI changes during follow-up in patients with acute myocardial infarction with systolic dysfunction and/or heart failure: insights from the High-Risk Myocardial Infarction Initiative

BACKGROUND

In patients with acute myocardial infarction (MI), BMI < 18.5 kg/m² and a decrease in BMI during follow-up have been associated with poor prognosis. For BMI ≥ 25 kg/m², an "obesity paradox" has been suggested. Recently, high visit-to-visit BMI variability has also been associated with poor prognosis in patients with coronary artery disease.

AIMS

To simultaneously evaluate several BMI measurements and study their association with cardiovascular (CV) outcomes in a large cohort of patients with acute myocardial infarction (MI) and left ventricular (LV) systolic dysfunction, heart failure (HF) or both.

METHODS

The high-risk MI dataset is pooled from four trials: CAPRICORN, EPHESUS, OPTIMAAL and VALIANT. Mean BMI, change from baseline, and variability were assessed during follow-up. The primary outcome was CV death. Cox-proportional hazard models were performed to study the association between the various BMI parameters and outcomes (median follow-up = 1.8 years).

RESULTS

A total of 12,719 patients were included (72% male, mean age 65 ± 11 years). Mean, change and visit-to-visit variability in BMI had a non-linear association with CV death (P < 0.001). Mean BMI < 26 kg/m² (vs. ≥ 26-35 kg/m²) and BMI decrease during follow-up were independently associated with CV death (adjusted HR 1.32, 95% CI 1.16-1.51, P < 0.001 and adjusted HR 1.57, 95% CI 1.40-1.76, P < 0.001, respectively). Low and high BMI variability (< 2% and > 4%) were associated with increased event-rates, but lost statistical significance in sensitivity analysis including patients with ≥ 5 measurements or excluding patients with HF hospitalization, suggesting that BMI variability may be particularly associated with HF hospitalizations.

CONCLUSION

Mean BMI < 26 kg/m² and a BMI decrease during follow-up were independently associated with CV death in patients with MI and LV systolic dysfunction, HF or both. These associations likely reflect poorer patient status and causality cannot be inferred.

Two-hour post-challenge hyperglycemia, but not fasting plasma glucose, associated with severity of coronary artery disease in patients with angina

INTRODUCTION

Postprandial hyperglycemia plays a pivotal role in cardiovascular disease. However, few studies have investigated associations between the severity of coronary artery disease (CAD) and postprandial glucose levels in angina patients without known diabetes before coronary angiography.

METHODS

Subjects who were admitted for coronary angiography due to angina and were in stable condition after discharge were recruited. A standard 75-g oral glucose tolerance test (OGTT) was performed at outpatient visits approximately 2-4 weeks after hospital discharge, and fasting and post-challenge blood glucose were measured. Twenty-six volunteers in our hospital staff served as the healthy group. CAD severity was graded using the SYNTAX and Jeopardy scoring systems.

RESULTS

The subjects in the angina group had a higher body mass index, higher fasting glucose, and higher 2-h postprandial glucose than those in the healthy group. The SYNTAX and Jeopardy scores were significantly associated with 2-h postprandial blood glucose (correlation coefficients = 0.164 and 0.187, respectively) but not with fasting glucose. Linear regression analyses revealed that SYNTAX and Jeopardy scores were independently associated with glucose levels at 120 min after OGTT (SYNTAX 95%CI = 0.003-0.103; Jeopardy score 0.002-0.027) but not with fasting glucose.

CONCLUSION

CAD severity is associated with blood glucose levels after oral glucose challenge in patients without known diabetes before coronary angiography, suggesting that CAD patients should be routinely screened for post-challenge blood glucose.

Mendelian randomisation in type 2 diabetes and coronary artery disease

Type 2 diabetes, coronary artery disease and hypertension are associated with anthropometric and biomarker traits, including waist-to-hip-ratio, body mass index and altered glucose and insulin levels. Clinical trials, for example of weight-loss interventions, show these factors are causal, but lifelong impact of subtle changes in body mass index and body fat distribution are less clear. The use of human genetics can quantify the causal effects of long-term exposure to subtle changes of modifiable risk factors. Mendelian randomisation (MR) uses human genetic variants associated with the risk factor to quantify the relationship between risk factor and disease outcome. The last two years have seen an increase in the number of MR studies investigating the relationship between anthropometric traits and metabolic diseases. This review provides an overview of these recent MR studies in relation to type 2 diabetes, coronary artery disease and hypertension. MR provides evidence for causal associations of waist-to-hip-ratio, body mass index and altered glucose levels with type 2 diabetes, coronary artery disease and hypertension.