Relation of Obesity to Acute Myocardial Infarction in Japanese Patients Differences in Gender and Age

Association Between Waist Circumference and the Prevalence of (Pre) Hypertension Among 27,894 US Adults

Aims: This study aimed to investigate the association between waist circumference and the prevalence of (pre) hypertension.

Methods: Cross-sectional data from the 2007–2018 National Health and Nutrition Examination Survey were analyzed. The historical trend of abdominal obesity was assessed by the Cochran–Armitage trend test. After preprocessed by the multiple imputation strategy, we used generalized additive models to assess the association of waist circumference with systolic/diastolic blood pressure and performed correlation analysis by the Spearman correlation coefficient. Moreover, we used multivariable logistic regression (non-adjusted, minimally adjusted, and fully adjusted models), restricted cubic spline, and sensitivity analysis to investigate the association between waist circumference and (pre) hypertension.

Results: A total of 27,894 participants were included in this study. In the fully adjusted model, waist circumference was positively associated with (pre) hypertension with odds ratios (95% confidence intervals) of 1.28 (1.18–1.40) in the young group and 1.23 (1.15–1.33) in the old group. Restricted cubic spline showed a higher prevalence of (pre) hypertension with the increase of waist circumference. In the subgroup analysis, waist circumference showed a robust trend across all BMI categories with odds ratios (95% confidence intervals) of 3.33 (1.29–8.85), 1.35 (1.17–1.57), 1.27 (1.13–1.41), and 1.09 (1.01–1.17) in underweight, normal weight, overweight, and obese individuals, respectively.

Conclusion: This study highlighted waist circumference as a significant biomarker to evaluate the risk of (pre) hypertension. Our results supported the measure of waist circumference regardless of BMI when evaluating the cardiometabolic risk related to fat distribution.

Obesity May Not Be a Risk of Non-Target Lesion Revascularization in the Elderly Patients

Obesity is assumed to be one of the robust risk factors for coronary artery disease. However, the effects of obesity on the progression of atherosclerosis in patients in different age groups after percutaneous coronary intervention (PCI) remain unclear. This study aimed to examine the effect of obesity on prognosis in different age groups.Consecutive patients who underwent urgent or elective PCI were surveyed for this study and were then divided into the elderly group and middle-aged group with a cut-off age of 70 years. All patients underwent coronary angiography or coronary computed tomography angiography 1 year after PCI to examine the progression of atherosclerosis. The primary endpoint was revascularization for a new lesion within 2 years after PCI. In addition, the main effects and correlations between obesity and age were examined. Multivariate logistic regression analysis was conducted to identify independent predictors of non-target lesion revascularization (non-TLR).Of the 711 patients who met the criteria and were available for follow-up analysis, the incidence of non-TLR within 2 years was 97/711 (13.6%). The higher incidence of non-TLR in patients with obesity was observed only in the middle-aged group. Furthermore, in the multivariate analysis, obesity was independently associated with non-TLR only in the middle-aged group.The findings of the present study would enable us to construct the hypothesis that obesity in elderly patients may not be an independent predictor of the incidence of non-TLR, indicating that the management to prevent non-TLR may vary depending on the age of the patient.

Comparison of visceral and body fat indices and anthropometric measures in relation to untreated hypertension by age and gender among Chinese

BACKGROUND

The aim of the study was to compare the efficiency of bioelectrical indices (percentage body fat, PBF; visceral fat index, VFI) and various anthropometric measures (body mass index, BMI; waist circumference, WC; waist-to-height ratio, WHtR) on determining hypertension in Chinese.

METHODS

We conducted the community-based cross-sectional survey during August of 2013 to August of 2015 in 66 sample sites selected by multistage random sampling method from Henan province. 14,364 residents were included in the study.

RESULTS

In both genders, VFI and PBF tended to rise with age. However, for each age-specific group, men consistently had significantly greater VFI than women (all P<0.0001) and women had considerably higher PBF (all P<0.0001). The odds ratios and area under the ROC curves (AUCs) for hypertension associated with adiposity indices decreased with age. In younger (15~34year) men and women, VFI had the highest crude (2.43-7.95) and adjusted (2.40-11.63) odds ratio for hypertension. The AUCs for PBF, VFI and WHtR were significantly larger than those for BMI and WC (all P<0.01). Whereas no statistically significant difference were found in AUCs among PBF, VFI and WHtR (all P>0.10). Additionally, VFI and PBF yielded the greatest Youden index in identifying hypertension in men (0.27) and women (0.34), respectively. Optimal cutoffs for VFI/PBF were 11.70/24.45 and 7.55/33.65 in men and women, respectively.

CONCLUSIONS

VFI and PBF could be better candidates for identifying hypertension in men and women, respectively. Adolescents and young adults should be highlighted in preventing hypertension by control of excess body and visceral fat.

Does an Obesity Paradox Really Exist After Cardiovascular Intervention?: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies

Several studies have shown the existence of an obesity paradox after Percutaneous Coronary Intervention (PCI). However, other studies have shown its absence. This study sought to perform a systematic review and meta-analysis of studies comparing the mortality risk between high body mass index patients and normal weight patients after PCI.We have searched PubMed, Embase, and Chinese medical journal for randomized controlled trials (RCTs) and observational studies published between the year 2000 and 2015 by typing the keywords "percutaneous coronary intervention" and "obesity paradox." The main outcome was "all-cause mortality". RevMan 5.3 software was used to calculate the risk ratio (RR) with 95% confidence interval (CI) to express the pooled effect on discontinuous variables.Twenty-two studies have been included in this meta-analysis consisting of a total of 242,377 patients with 73,143 normal weight patients, 103,608 overweight, and 65,626 obese patients. Younger age, higher cardiovascular risk factors and the intensive use of medications have mainly been observed among obese patients followed by overweight and normal weight patients respectively. In-hospital, 12 months and ≥ 1 year (long-term) mortality risks were significantly lower in the overweight and obese groups with (RR: 0.67; 95% CI: 0.63-0.72, P < 0.00001) and (RR: 0.60; 95% CI: 0.56-0.65, P < 0.00001) respectively in the in-hospital follow-up (RR: 0.62; 95% CI: 0.55-0.71 and 0.57; 95% CI: 0.52-0.63, P < 0.00001) at 12 months, and (RR: 0.70; 95% CI: 0.64-0.76; P < 0.00001) and (RR: 0.80; 95% CI: 0.71-0.91, P = 0.0006) respectively for the long-term follow-up after PCI.This "obesity paradox" does exist after PCI. The mortality in overweight and obese patients is really significantly lower compared to the normal weight patients. However, the exact reasons for this phenomenon need further exploration and research in the future.

Interaction between selenium and mercury in biological samples of Pakistani myocardial infarction patients at different stages as related to controls

It has been speculated that trace elements may a play role in the pathogenesis of heart diseases. In the present study, we aimed to assess the levels of selenium (Se) and mercury (Hg) in biological samples (whole blood, urine, and scalp hair) of myocardial infarction (MI) patients of both genders (age range 45-60 years) at the first, second, and third heart attack (n = 130), hospitalized in a cardiac ward of a civil hospital of Hyderabad City (Pakistan). For comparison, healthy age-matched referent subjects (n = 61) of both genders were also selected. Se and Hg in biological samples were measured by electrothermal atomic absorption spectrometry and cold vapor atomic absorption spectrometry, prior to microwave acid digestion, respectively. The validity of the methodology was checked by biological certified reference materials. During this study, 78 % of the 32 registered patients of third MI attack (aged >50 years) died. The concentration of Se was decreased in scalp hair and blood samples of MI patients, while Hg was higher in all biological samples as compared to referent subjects. Se concentration was inversely associated with the risk of MI attacks in both genders. These results add to an increasing body of evidence that Se is a protective element for cardiovascular health.

Age-dependent decline of association between obesity and hyperglycemia in men and women

OBJECTIVE

The purpose of this study was to determine whether age influences the association between obesity and hyperglycemia.

RESEARCH DESIGN AND METHODS

The subjects were 57,576 Japanese male and female workers aged 35-70 years. The associations of adiposity indices, including BMI, waist circumference, and waist-to-height ratio, with risk for hyperglycemia were compared among different age groups (35-39, 40-49, 50-59, and 60-70 years) using odds ratios (ORs).

RESULTS

There were significant trends for the crude ORs of obese subjects versus nonobese subjects for hyperglycemia to be lower as age increased in men and women. Multivariate logistic regression analysis showed these trends of age-dependent decreases in ORs for hyperglycemia were not altered by adjustment for confounders such as smoking, alcohol drinking, and habitual exercise.

CONCLUSIONS

The results suggest that the association between obesity and hyperglycemia declines with age in men and women.

Prospective care of heart failure in Japan: lessons from CHART studies

There are approximately 23 million patients with heart failure (HF) worldwide. The prognosis of patients with HF is still poor and a prospective approach for preventing and treating HF is necessary. The number of HF patients in Japan has been increasing since 1950 mainly because of a rapidly aging population. Furthermore, westernized dietary pattern, reduced physical activity, and obesity have become prominent, particularly in younger Japanese men. There is an increasing trend of diabetes and dyslipidemia, and the prevalence of smoking and hypertension continues to remain high. One of the largest HF cohorts in Japan, the CHART Studies, showed that coronary artery disease (CAD) was the most frequent etiology of HF currently. Thus, prospective strategies including accurate risk stratification, effective prevention of disease progression through evidence-based treatments, optimally personalized treatment particularly in elderly individuals, and life-long control of CAD risk factors are required to manage HF in Japan.

Absolute value of bioelectrical impedance analysis-measured visceral fat area with obesity-related cardiovascular risk factors in Japanese workers

AIM

The accumulation of Visceral fat is known to precede metabolic disorders and atherosclerosis. This study aimed to determine the relationships between body mass index (BMI), waist circumference (WC), estimated visceral fat area (eVFA) measured by bioelectrical impedance analysis (BIA), and obesity-related cardiovascular risk factors.

METHODS

The study population was 2,870 middle-aged Japanese employees (males/females=2,322/ 548), who had undergone a health check-up.

RESULTS

In the receiver operating characteristic (ROC) curve, the cutoff levels yielding maximal sensitivity plus specificity for predicting the prevalence of ≥ 2 risks were, 24.5 kg/m(2) for BMI, 84.6 cm for WC, and 111 cm(2) for eVFA in males, and 23.6 kg/m(2), 81.5 cm, and 67 cm(2) in females. The average number of risk factors was over 1.0 in those with a BMI ≥ 25 kg/m(2) and with a WC ≥ 85 cm for males, ≥ 28 kg/m(2) and ≥ 95 cm respectively for females, and those with an eVFA ≥ 100 cm(2) for both males and females. In males, it was around 1.0 with cutoff levels of BMI, WC, and eVFA from the ROC curve. However, in females, it was around 0.6, because the prevalence of subjects with obesity and multiple risks was very low.

CONCLUSIONS

These results suggested that the cutoff level for visceral fat reduction should be set based on an absolute value of risk factors, rather than a calculated value. In regular health check-up, it may be useful to set an absolute cutoff value for eVFA at 100 cm(2) as criteria to screen for multiple obesity-related cardiovascular risk factors.

Impact of having one cardiovascular risk factor on other cardiovascular risk factor levels in adolescents

AIM

Little is known about the impact of having one cardiovascular (CV) risk factor on the levels of other CV risk factors in the general adolescent population. We hypothesized that when adolescents have one CV risk factor, the levels of other CV risk factors worsen simultaneously.

METHODS

Subjects consisted of 1,257 healthy adolescent volunteers (549 males and 708 females) aged 15-18 years. Abdominal obesity, hypertension, raised triglyceride levels, decreased HDL-cholesterol levels and hyperglycemia were used as CV risk factors. Homeostasis assessment of insulin resistance (HOMA-IR) was used as a surrogate marker of insulin resistance. Levels of four biomarkers, leptin, adiponectin, high-sensitive C-reactive protein, and desacyl-ghrelin, were also determined. Cut-offs for gender-specific individual CV risk factor levels were based on the 90th (or 10th) percentile values of the subjects in the present study.

RESULTS

The levels of all CV risk factors and HOMA-IR significantly and simultaneously worsened when adolescents had one CV risk factor in both genders. Having any one CV risk factor indicated the development of other CV risk factors in adolescents; in particular, we found that the development of abdominal obesity in male subjects had a harmful effect on the levels of other CV risk factors and was associated with the worsening of all four biomarkers examined.

CONCLUSIONS

It is important to determine the presence or absence of these CV risk factors before and/or during adolescence, because having one CV risk factor indicates the start of an accumulation of CV risk factors in the general adolescent population.

Obesity as a risk factor for coronary events in Japanese patients with hypercholesterolemia on low-dose simvastatin therapy

AIM

We previously reported that obesity (defined as a body mass index (BMI) >or=25 kg/m(2)) was not an independent risk factor for coronary heart disease (CHD) in hypercholesterolemic patients without a history of CHD from the Japan Lipid Intervention Trial (J-LIT). In this study, the obese J-LIT subgroup was further analyzed to assess CHD risk.

METHODS

In the J-LIT study, patients received simvastatin treatment (usually at 5 mg/day) for 6 years. A total of 38,385 patients (mean age: 57.7+/-7.9, 12,111 men) without prior CHD and/or stroke were analyzed.

RESULTS

In this cohort, 181 CHD (acute myocardial infarction or sudden cardiac death) were observed. Obesity (n=12,929) was not an independent risk factor for CHD (relative risk; 1.18, 95% confidence interval; 0.87?1.59) after adjustment for the major risk known factors, such as age, sex, hypertension, diabetes mellitus (DM), and smoking. However, blood pressure, triglycerides, and fasting plasma glucose all increased, while high-density lipoprotein-cholesterol decreased, with increased BMI. The percentage of patients having two or three risk factors (such as dyslipidemia, hypertension, and DM) also increased with increased BMI.

CONCLUSIONS

Obesity was not an independent risk factor for CHD in hypercholesterolemic patients on statin therapy; however, it is important to control obesity, a condition in which CHD risks accumulate, in order to improve associated risk factors along with the treatment of each risk factor, thus further reducing the risk of CHD.

Inflammation in atherosclerosis: transition from theory to practice

Inflammation drives the formation, progression, and rupture of atherosclerotic plaques. Experimental studies have demonstrated that an inflammatory subset of monocytes/macrophages preferentially accumulate in atherosclerotic plaque and produce proinflammatory cytokines. T lymphocytes can contribute to inflammatory processes that promote thrombosis by stimulating production of collagen-degrading proteinases and the potent procoagulant tissue factor. Recent data link obesity, inflammation, and modifiers of atherosclerotic events, a nexus of growing clinical concern given the worldwide increase in the prevalence of obesity. Modulators of inflammation derived from visceral adipose tissue evoke production of acute phase reactants in the liver, implicated in thrombogenesis and clot stability. Additionally, C-reactive protein levels rise with increasing levels of visceral adipose tissue. Adipose tissue in obese mice contains increased numbers of macrophages and T lymphocytes, increased T lymphocyte activation, and increased interferon-gamma (IFN-gamma) expression. IFN-gamma deficiency in mice reduces production of inflammatory cytokines and inflammatory cell accumulation in adipose tissue. Another series of in vitro and in vivo mouse experiments affirmed that adiponectin, an adipocytokine, the plasma levels of which drop with obesity, acts as an endogenous antiinflammatory modulator of both innate and adaptive immunity in atherogenesis. Thus, accumulating experimental evidence supports a key role for inflammation as a link between risk factors for atherosclerosis and the biology that underlies the complications of this disease. The recent JUPITER trial supports the clinical utility of an assessment of inflammatory status in guiding intervention to limit cardiovascular events. Inflammation is thus moving from a theoretical concept to a tool that provides practical clinical utility in risk assessment and targeting of therapy.

Effects of mild calorie restriction and high-intensity interval walking in middle-aged and older overweight Japanese

We investigated whether a combination of mild calorie restriction (MCR) and high-intensity interval walking (HIW) improved physical fitness more than HIW alone in middle-aged and older overweight Japanese (40-69years old, BMI23.6kg/m(2)). Forty-seven women and 16 men were divided into MCR+HIW and HIW groups. All subjects performed HIW: 5 sets of 3-min low-intensity walking (40% peak aerobic capacity for walking, VO(2peak)) and 3-min high-intensity walking (70% VO(2peak)) per day, 4days per week, for 16weeks while energy expenditure was monitored with a tri-axial accelerometer. The MCR+HIW group consumed meal replacement formula (240kcal): a mixture of low-carbohydrates and -fat and high-protein, for either lunch or dinner everyday and therefore, had approximately 87% of the energy intake of the HIW group during the intervention period. Although the HIW group showed improvements in BMI, blood pressure, and several blood chemicals, the MCR+HIW group had greater improvement. Moreover, the medical expenditure for the 6months including the intervention period was 59% lower in the MCR+HIW group than in the HIW group. Our strategy of a short-term combination of MCR and HIW may thus prevent lifestyle-associated diseases and improve health in middle-aged and older overweight Japanese.

Associations between metabolic syndrome and mortality from cardiovascular disease in Japanese general population, findings on overweight and non-overweight individuals. Ibaraki Prefectural Health Study

BACKGROUND

The impact of being overweight, as a component of the metabolic syndrome (MetS), for cardiovascular disease (CVD) mortality was investigated and compared with the predictive value of MetS by 2 different definitions.

METHODS AND RESULTS

A 12-year prospective study of 30,774 Japanese men and 60,383 women aged 40-79 years was conducted. The multivariate hazard ratio (HR; 95% confidence interval) of total CVD mortality for overweight subjects with >or=2 additional risk factors with reference to subjects with 0 of 4 MetS components was 1.83 (1.41-2.38) for men and 1.90 (1.45-2.49) for women, and for non-overweight subjects with >or=2 additional risk factors 1.75 (1.38-2.24) and 1.97 (1.52-2.55), respectively. The proportion of excess CVD deaths in the latter group was 1.5-fold higher than that in the former group. Multivariate HRs of coronary heart disease and total CVD mortality for MetS by the modified criteria of the American Heart Association/National Heart, Lung, and Blood Institute were 1.62 (1.31-2.00) and 1.23 (1.09-1.39), respectively, for men and 1.32 (1.05-1.65) and 1.12 (1.00-1.25), respectively, for women. The respective HRs for MetS by the International Diabetic Federation definition did not reach statistical significance, except for coronary heart disease in men.

CONCLUSIONS

Non-overweight individuals with metabolic risk factors, as well as overweight individuals with such factors, should be targeted to reduce the CVD burden in the general population.

Age- and gender-related differences in correlations between abdominal obesity and obesity-related metabolic risk factors in Japanese

BACKGROUND

There have been conflicting data regarding the relationship between obesity and coronary heart disease (CHD) in Japan. Obesity was reported to be a risk factor of CHD in young and middle-aged males, but not in females or older males. The age- and gender-related differences in the correlations between obesity and obesity-related metabolic risk factors might contribute to these conflicting data.

METHODS

Medical check-up data from 1,360 men and 821 women were divided into younger (= or < 51-year-old) and older (> 51-year-old) groups according to the median age and Spearman's correlation coefficients between waist circumference (WC) and obesity-related metabolic risk factors were calculated.

RESULTS

The correlation coefficients between WC and triglyceride and between WC and high-sensitivity C-reactive protein (hs-CRP) were significantly stronger in younger men than in older men. There was no statistically significant difference in correlation coefficients between younger and older women. The correlation coefficients between WC and triglyceride, WC and HDL cholesterol, WC and hs-CRP, WC and gamma glutamyltransferase, and WC and alanine aminotransferase (ALT) were significantly stronger in younger men than in younger women. The correlation coefficient between WC and ALT was significantly stronger in older men than in older women. And the correlations between WC and SBP, WC and DBP, and WC and GGT tended to be stronger in younger men than in older men.

CONCLUSION

The correlations between abdominal obesity and obesity-related metabolic risk factors were stronger in younger men than in older men and women among Japanese.

Relationships between indices of obesity and its cardiovascular comorbidities in a Chinese population

BACKGROUND

Current definitions of overweight/obesity and central adiposity guidelines are based on Western populations, and may not be appropriate for the Chinese population. More data among Chinese are needed to address this issue. We aimed to identify cut-offs for body mass index (BMI) and waist circumference that confer increased risk of cardiovascular disease in a Chinese population in Shanghai.

METHODS AND RESULTS

A representative, cross-sectional sample of 13,817 adults aged >18 years was studied in Shanghai. In men and women, blood pressure (systolic and diastolic), total cholesterol, low-density lipoprotein-cholesterol, triacylglycerol, and glucose values were incrementally higher and mean high-density lipoprotein-cholesterol values were incrementally lower with increased BMI and waist circumference. Both the point at which sensitivity equaled specificity and the shortest distance in the receiver operating characteristic curves for hypertension, dyslipidemia, diabetes, or >or=2 of these risk factors generally suggested a BMI cut-off value of 24 kg/m(2) for both men and women, and a waist circumference cut-off value of 85 cm for men and 80 cm for women.

CONCLUSIONS

A BMI cut-off of 24 kg/m(2) for both men and women, and a waist circumference cut-off of 85 cm for men and 80 cm for women might be appropriate for use in identifying adults at high risk of developing cardiovascular disease and serve as public health action thresholds in Shanghai residents.

Association between the number of cardiovascular risk factors and each risk factor level in elementary school children

BACKGROUND

Little is known regarding the association between numbers of cardiovascular (CV) risk factors and the level of each risk factor in elementary school children based on a longitudinal study.

METHODS AND RESULTS

A descriptive study of 319 obese children aged 6-11 years who participated in a screening program for comorbidity of obesity between 2003 and 2005, and who participated in consecutive years thereafter, was performed. Abdominal obesity, hypertension, dyslipidemia (low high-density lipoprotein-cholesterol levels and/or high triglyceride levels), and raised fasting glucose levels were used as the CV risk factors. Metabolic syndrome and each CV risk factor were defined using the criteria newly established by a Task Force financed by the Health and Labour Science Research in Japan. An increase in the total number of CV risk factors implied a worsening of each CV risk factor level over a 1-year interval, and vice versa. Abdominal obesity in males and insulin resistance in females were prevalent in children who were at elementary school level.

CONCLUSIONS

We should assess not only obesity but all CV risk factor levels, because a cluster of risk factors implies a worsening of the individual risk factor levels in children as young as those in elementary school.

Impact of body mass index on in-hospital outcomes after percutaneous coronary intervention for ST segment elevation acute myocardial infarction

BACKGROUND

The impact of body mass index (BMI) on outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) remains unclear.

METHODS AND RESULTS

A total of 3,076 patients undergoing PCI for AMI within 48 h after symptom onset were studied. Patients were divided into 4 groups according to baseline BMI: lean (<20 kg/m(2)), normal weight (20.0-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)) and obese (>or=30.0 kg/m(2)). Obese patients were younger and had a higher frequency of diabetes mellitus, hyperlipidemia, hypertension and smoking. Lean patients were older, usually women and had a lower frequency of the aforementioned risk factors. Killip class on admission, renal insufficiency, and final Thrombolysis In Myocardial Infarction (TIMI) flow grade did not differ among the 4 groups. In lean, normal weight, overweight and obese patients, in-hospital mortality was 9.2%, 4.4%, 2.5% and 1.8%, respectively (p<0.01). Multivariate analysis showed that compared with normal weight patients, odds ratios for in-hospital death in lean, overweight and obese patients were 1.92, 0.79 and 0.40, respectively (p=NS). Independent predictors were age, Killip class on admission, renal insufficiency and final TIMI flow grade.

CONCLUSION

BMI itself had no impact on in-hospital mortality in patients undergoing primary PCI for AMI. The phenomenon ;obesity paradox' may be explained by the fact that obese patients were younger at presentation.

Body mass index and blood pressure in adult type 2 diabetic patients in Taiwan

BACKGROUND

The correlation between body mass index (BMI)/obesity and blood pressure/hypertension has not been confirmed in diabetic patients. This study analyzed the association in Taiwanese adult patients with type 2 diabetes mellitus (T2DM).

METHODS AND RESULTS

The National Health Insurance data of 89,857 adult patients (41,398 men and 48,459 women; aged >or=18 years with mean +/- SD of 62.2+/-11.3 years) interviewed by questionnaire were analyzed, taking into account the potential confounding of age, sex, diabetic duration, smoking and parental hypertension. Prevalence of obesity (BMI >or=25 kg/m2) was 39.3% and 41.7% in the diabetic men and women, respectively; and hypertension was 54.5% in both sexes. Hypertension increased significantly with increasing age and BMI. The adjusted odds ratio (OR) for hypertension for every 1 kg/m(2) increment of BMI was 1.16 (1.15-1.17) and 1.13 (1.12-1.14) for men and women, respectively. The correlation between BMI and hypertension/blood pressure extended throughout BMI levels to the nonobese range. For men, adjusted OR for BMI <18.5, 18.5-22.9, 23.0-24.9, 25.0-29.9 and >or=30.0 kg/m2 were 1.00, 1.23 (1.07-1.41), 1.78 (1.55-2.05), 3.06 (2.66-3.53) and 6.59 (5.56-7.82), respectively; and were 1.00, 1.09 (0.97-1.22), 1.49 (1.32-1.68), 2.32 (2.06-2.60), 4.40 (3.84-5.05), respectively, for women. For every 1 unit BMI increase in patients without a hypertension history, the systolic and diastolic blood pressures significantly increased by 0.618 and 0.447 mmHg for men; and by 0.637 and 0.462 mmHg, respectively, for women.

CONCLUSIONS

BMI/obesity is significantly linked to blood pressure/hypertension throughout the range of BMI in diabetic patients in either sex regardless of a previous hypertension history.

Comparison of clinical characteristics and arterial remodeling by intravascular ultrasonic imaging in three age groups (< or =55, 56 to 69 and > or =70 years) of Japanese patients with acute myocardial infarction

Recent epidemiologic, pathologic, and intravascular ultrasound (IVUS) studies have shown that there are differences in coronary risk factors or plaque morphology between younger and older patients with acute myocardial infarctions (AMIs). This study examined clinical background and plaque morphology using IVUS in younger and older adults with AMIs in Japan. The study population consisted of 96 patients with AMIs, for whom preinterventional IVUS images were obtained. Patients were classified into 3 groups: a young group (aged < or =55 years), a middle-aged group (aged 56 to 69 years), and an old group (aged > or =70 years). The remodeling index was defined as the ratio of the external elastic membrane area at the culprit lesion to the external elastic membrane area at the proximal reference site. Expansive remodeling was defined as a remodeling index >1.05 and constrictive remodeling as a remodeling index <0.95. The frequency of hypercholesterolemia was significantly different among the 3 age groups. Total cholesterol (p <0.001), low-density lipoprotein cholesterol (p <0.005), and triglyceride (p <0.05) levels and body mass index (p <0.001) in the young group were significantly higher than in the old group. On IVUS images, constrictive remodeling was most common in the young group, whereas expansive remodeling occurred most commonly in the middle-aged and old groups. In conclusion, this study demonstrated that patients with AMIs in the young group had higher levels of hypercholesterolemia, obesity, and constrictive remodeling compared with those in the old group. The differences in arterial remodeling of the culprit lesions between younger and older patients with AMIs may reflect different biologic mechanisms of plaque activation and destabilization.

In-Hospital Outcomes of Primary Percutaneous Coronary Interventions Performed at Hospitals With and Without On-Site Coronary Artery Bypass Graft Surgery

BACKGROUND

Primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is performed in hospitals without on-site coronary artery bypass graft surgery in the ;real world'. However, data on the in-hospital outcomes of primary PCI performed at hospitals with and without on-site cardiac surgery are still lacking in Japan.

METHODS AND RESULTS

In the present study, 2,230 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2005. Of these, 1,817 patients underwent primary PCI. Excluding patients without adequate data, we retrospectively compared clinical background, coronary risk factors, angiographic findings, acute results of primary PCI and in-hospital prognosis between patients undergoing primary PCI in hospitals without on-site cardiac surgery (without surgery group, n=792) and those in hospitals with (with surgery group, n=993). The without surgery group had higher prevalence of previous myocardial infarction, Killip class>or=3 at admission and multivessels as a culprit lesion than the with surgery group. The without surgery group was more likely to have lower frequency of stent usage and lower thrombolysis in myocardial infarction flow grade just after PCI, whereas it was more likely to have intra-aortic balloon pumping and temporary pacing during procedures. The overall in-hospital mortality did not differ between the 2 groups. On multivariate analysis, in AMI patients undergoing primary PCI, Killip class>or=3 at admission, multivessels or left main trunk (LMT) as culprit lesions, number of diseased vessels>or=2 or diseased LMT, and age were the independent predictors of the in-hospital mortality, but the presence of on-site cardiac surgery was not.

CONCLUSIONS

These results suggest that in-hospital outcomes in AMI patients undergoing primary PCI at hospitals without on-site cardiac surgery are comparable to those at hospitals with on-site cardiac surgery in Japan.