Association between obesity grade and the age of the first acute coronary syndrome: Prospective observational study

https://doi.org/10.1016/j.ijcard.2021.11.080Get rights and content

Highlights

  • BMI is inversely correlated with the age of the first ACS episode.

  • Severely obese patients experience ACS 7 years earlier than normal-weight patients.

  • Effect of obesity on the age of ACS may diminish in the absence of CV risk factors.

Abstract

Background

The study evaluates how obesity grade is associated with age during the first acute coronary syndrome (ACS) and examines the effect of cardiovascular (CV) risk factors and the age of first ACS in patients with severe obesity.

Methods

We enrolled consecutive patients diagnosed with first episode of ACS between 2014 and 2019, and categorized them by body mass indices (BMI). Severe obesity was defined as BMI ≥35 kg/m2. Independent variables affecting the age of first ACS were examined by linear regression analysis.

Results

A total of 1005 patients (mean age, 57.5 ± 12.3 years; 19.3% female) were included. Approximately 6% and 12% of obese patients and normal weight patients had no other risk factors. Patients with ACS with severe obesity were younger than those with ACS in the grade-I obesity, overweight, and normal-weight groups (52.8 ± 9.9 vs. 55.3 ± 10.9, 56.8 ± 11.4, and 61.4 ± 14.2, respectively, p < 0.001). BMI had a strong, inverse linear relationship with earlier age of first ACS. The number of patients with no risk factors was significantly high in normal-weight individuals compared with patients with severe obesity (11.6% vs 5.6%, p = 0.037). After adjusting for CV risk factors, patients with overweight, grade-I obesity, and severe obesity may experience first ACS sooner than those with normal-weight by 3.9, 6.1, and 7.7 years, respectively (p < 0.001). However, males and females with severe obesity without CV risk factors experienced the first ACS episode 16 and 22 years later than those with the highest number of risk factors, respectively.

Conclusion

Patients with severe obesity experience first ACS episode 7.7 years earlier than those with normal-weight. Absence of CV risk factors in people with obesity can improve the potential negative effect of obesity on the ACS age.

Trial registration: NCT04578964, 08 October 2020.

Section snippets

List of abbreviations

ACE-Iangiotensin converting enzyme-inhibitors
ACSacute coronary syndrome
ARBangiotensin receptor blockers
BBbeta blockers
BMIbody mass index
CAGcoronary angiography
CVcardiovascular
CVDcardiovascular disease
HLDhyperlipidemia
HTNhypertension
LDL-Clow-density lipoprotein cholesterol
MHOmetabolically healthy obese
MImyocardial infarction
MONWmetabolically obese but has a normal weight
MUOmetabolically unhealthy obese
NSTE-ACSnon–ST-elevated acute coronary syndrome
STEMIST-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)

  • C.J. Ellis et al.

    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.

    (2019)
  • A.D. Karelis

    Metabolically healthy but obese individuals

    Lancet

    (2008)
  • T. Adair et al.

    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.

    (2020)
  • D.N. Vikulova et al.

    Premature atherosclerotic cardiovascular disease: trends in incidence, risk factors, and sex-related differences, 2000-2016

    J. Am. Heart Assoc.

    (2019)
  • J.P. Despres et al.

    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

    (2016)
  • C.M. Kitahara et al.

    Association between class III obesity (BMI of 40-59 kg/m2) and mortality: a pooled analysis of 20 prospective studies

    PLoS Med.

    (2014)
  • J.A. Suwaidi et al.

    Obesity is associated with premature occurrence of acute myocardial infarction

    Clin. Cardiol.

    (2001)
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    These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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