Association between obesity grade and the age of the first acute coronary syndrome: Prospective observational study
Section snippets
List of abbreviations
ACE-I angiotensin converting enzyme-inhibitors ACS acute coronary syndrome ARB angiotensin receptor blockers BB beta blockers BMI body mass index CAG coronary angiography CV cardiovascular CVD cardiovascular disease HLD hyperlipidemia HTN hypertension LDL-C low-density lipoprotein cholesterol MHO metabolically healthy obese MI myocardial infarction MONW metabolically obese but has a normal weight MUO metabolically unhealthy obese NSTE-ACS non–ST-elevated acute coronary syndrome STEMI ST-elevated myocardial
Methods
This prospective observational study enrolled consecutive adult patients (>18 years) who were diagnosed with ACS for the first time and admitted to the Antalya Training and Research Hospital between 2014 and 2019. During the hospitalization period, face-to-face interviews and physical examinations were performed, and laboratory findings and CV risk factors were determined. The exclusion criteria were determined on three main bases. The first is receiving certain medications and situations that
Statistical analysis
We present normally distributed continuous variables by arithmetic mean ± standard deviation, non-normal distributed or ordered variables by median (interquartile range), and categorical variables by frequency and percentage. Normal distribution was analyzed by the Lilliefors-corrected Kolmogorov–Smirnov test. The homogeneity of the variances was determined by Levene's test. The dependent groups of categorical variables were compared by McNemar's test. Normally distributed continuous variables
Results
Ultimately, we included 1005 patients (194 females) presenting with first ACS. The mean age was 57.4 ± 12.3 years, while the mean BMI was 27.9 ± 4.6 kg/m2. Based on the BMI, 268 (26.7%) patients had a normal weight, 441 (43.9%) were overweight, 224 (22.3%) had obesity, and 72 (7.2%) had severe obesity. Table 1 lists the demographic characteristics of patients according to the BMI categories.
BMI had a significant, inverse linear relationship with age during the first ACS (p < 0.001, r: −0.206).
Discussion
The current study shows that obesity is an independent risk factor for premature ACS. As obesity aggravated, patient's age at first ACS decreased in both sexes. When STEMI and NSTE-ACS diagnoses are examined separately, an inverse correlation was found between obesity and the age of first ACS episode. However, females with severe obesity with the least number of risk factors experienced the first ACS episode 21.5 years later than those with the highest number of risk factors. In males, the age
Study limitations
The single-center design is a limitation of our study; however, the characteristics of the patient group are compatible with the multicenter TURKMI study [15]. The present study was conducted in the center with the highest ACS patient burden in Antalya. Antalya is one of the cities in Turkey with the highest number of immigrants. When the data were analyzed according to the immigration status of the patients, it was observed that half of the participating patients were migrants from other
Conclusions
Patients with severe obesity experienced their first ACS episode 7.7 years earlier than those with normal weight. However, the absence of CV risk factors in people with obesity eliminated the potential negative effect of obesity on the ACS age. For the prevention of premature ACS in individuals with obesity, the necessity of additional prevention strategy at an early age should be investigated through prospective cohort studies.
Ethics approval and consent to participate
This was approved by the ethics committee of Antalya Training and research center (2014-097). Written informed consent was obtained from all participants.
Availability of data and materials
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Funding
Not applicable.
Declaration of Competing Interest
The authors have no conflicts of interest to declare.
Acknowledgement
We would like to thank Prof. Dr. Atila Halil Elhan for statistical analysis support.
References (37)
- et al.
Tobacco use and second-hand smoke exposure in young adolescents aged 12-15 years: data from 68 low-income and middle-income countries
Lancet Glob. Health
(2016) - et al.
Healthy weight and obesity prevention: JACC health promotion series
J. Am. Coll. Cardiol.
(2018) - et al.
Metabolically healthy versus metabolically unhealthy obesity
Metabolism
(2019) - et al.
A sex-specific evaluation of predicted lean and fat mass composition and cardiovascular disease onset and progression: a combined analysis of the Attica and GREECS prospective epidemiological studies
Obes. Res. Clin. Pract.
(2019) - et al.
Obesity and age of first non-ST-segment elevation myocardial infarction
J. Am. Coll. Cardiol.
(2008) - et al.
Myocardial infarction in the “young”: risk factors, presentation, management and prognosis, presentation
Heart Lung Circ.
(2016) - et al.
Psychological stress reactivity and future health and disease outcomes: a systematic review of prospective evidence
Psychoneuroendocrinology
(2020) - et al.
Fatty acids and chronic low grade inflammation associated with obesity and the metabolic syndrome
Eur. J. Pharmacol.
(2016) - et al.
Role of microRNAs on adipogenesis, chronic low-grade inflammation, and insulin resistance in obesity
Nutrition
(2017) - et al.
An update on physical health and economic consequences of overweight and obesity
Diabetes Metab. Syndr.
(2018)
All-cause mortality following an acute coronary syndrome: 12-year follow-up of the comprehensive 2002 New Zealand acute coronary syndrome audit
Heart Lung Circ.
Metabolically healthy but obese individuals
Lancet
The role of overweight and obesity in adverse cardiovascular disease mortality trends: an analysis of multiple cause of death data from Australia and the USA
BMC Med.
Premature atherosclerotic cardiovascular disease: trends in incidence, risk factors, and sex-related differences, 2000-2016
J. Am. Heart Assoc.
Obesity and cardiometabolic disease
Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants
Lancet
Association between class III obesity (BMI of 40-59 kg/m2) and mortality: a pooled analysis of 20 prospective studies
PLoS Med.
Obesity is associated with premature occurrence of acute myocardial infarction
Clin. Cardiol.
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