Neck circumference and central obesity are independent predictors of coronary artery disease in patients undergoing coronary angiography

Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2600 CEP 90035-003, Porto Alegre, RS, Brazil.
American Journal of Cardiovascular Disease 11/2012; 2(4):323-30.
Source: PubMed


Excess of adiposity is a risk factor for coronary artery disease, but it remains unclear if the distribution of fat is an effect modifier or if the risk is mediate by hypertension, diabetes and dyslipidemia. We investigated the association of central in addition to general obesity with coronary artery disease (CAD). A case-control study was conducted in 376 patients, aged 40 years or more, with chronic coronary disease, undergoing elective coronary angiography. Excess of adiposity was evaluated by the Body Mass Index (BMI), waist circumference, waist-hip ratio, and neck circumference. Cases (n=155) were patients referred for coronary angiography with at least 50% of coronary stenosis in at least one epicardial vessels or their branches, with diameter greater than 2.5 mm. Controls (n=221) were patients referred for coronary angiography without significant coronary disease. Odds ratios and 95%CI for significant coronary stenosis were calculated using multiple logistic regression, controlling for age, sex, years at school, smoking, hypertension, HDL-cholesterol, diabetes mellitus, and an adiposity index. There was a predominance of men and individuals older than 50 years among cases. The waist-hip ratio increased four times the chance of CAD, even after the control for confounding factors, including BMI. Neck circumference above the 90(th) Percentile doubled the chance of CAD, after adjustment for traditional risk factors. Neck circumference and waist-hip ratio are independent predictors of CAD, even taking into account traditional risk factors for CAD. These findings highlight the need of anthropometric assessment among patients with suspected coronary artery disease.

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    • "NC was identified in our study as a significant clinical characteristic by multivariate regression analysis and was associated with the presence of hypertension in moderate to severe OSA patients. In recent studies, rostral fluid displacement in hypertensive patients has been linked to OSA by contributing to the narrowing of the upper airway,31,32 and NC could be increased by this fluid shift from the lower body.22,29,30,33,34 This result suggests that NC should not be overlooked in evaluating OSA patients. "
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    ABSTRACT: Purpose Obstructive sleep apnea (OSA) is considered an independent risk factor for hypertension. However, it is still not clear which clinical factors are related with the presence of hypertension in OSA patients. We aimed to find different physical features and compare the sleep study results which are associated with the occurrence of hypertension in OSA patients. Materials and Methods Medical records were retrospectively reviewed for patients diagnosed with OSA at Severance Cardiovascular Hospital between 2010 and 2013. Males with moderate to severe OSA patients were enrolled in this study. Clinical and polysomnographic features were evaluated to assess clinical variables that are significantly associated with hypertension by statistical analysis. Results Among men with moderate to severe OSA, age was negatively correlated with hypertension (odds ratio=0.956), while neck circumference was positively correlated with the presence of hypertension (odds ratio=1.363). Among the polysomnographic results, the lowest O2 saturation during sleep was significantly associated with the presence of hypertension (odds ratio=0.900). Conclusion Age and neck circumference should be considered as clinically significant features, and the lowest blood O2 saturation during sleep should be emphasized in predicting the coexistence or development of hypertension in OSA patients.
    Yonsei Medical Journal 09/2014; 55(5):1310-7. DOI:10.3349/ymj.2014.55.5.1310 · 1.29 Impact Factor

  • Journal of cardiothoracic and vascular anesthesia 08/2013; 27(4):806-808. DOI:10.1053/j.jvca.2013.03.004 · 1.46 Impact Factor
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    ABSTRACT: Background Neck circumference (NC) is associated with metabolic syndrome (MetS) in the general population. It is not known if NC is associated with MetS and subclinical atherosclerosis in retired National Football League (NFL) players.HypothesisWe hypothesized that NC is associated with MetS and subclinical atherosclerosis (assessed as coronary artery calcium [CAC] and carotid artery plaque [CAP]) in retired NFL players.MethodsNC was measured midway between the midcervical spine and midanterior neck in 845 retired NFL players. CAC presence was defined as total CAC score >0. CAP was defined as carotid plaque of at least 50% greater than that of the surrounding vessel wall, with a minimal thickness of at least 1.2 mm on carotid ultrasound. Logistic regression analysis was used for the association of NC with CAC or CAP.ResultsOf the participants, 21% had MetS. CAC and CAP were present in 62% and 56%, respectively. Those with MetS had a higher median NC than those without MetS (17 vs 16 inches, P < 0.0001). NC was not associated with the presence of CAC or CAP in an unadjusted model and after adjusting for age, race, and cardiometabolic risk factors (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 0.94–1.31 for CAC; OR: 0.96, 95% CI: 0.82–1.12 for CAP per 1-standard deviation increase in NC [3.8 inches]). The results were similar when the predictor variable was NC indexed to body mass index.Conclusions In retired NFL players with a high prevalence of CAC and CAP, NC was not associated with coronary or carotid subclinical atherosclerosis. NC may not be the most appropriate risk marker for atherosclerosis.
    Clinical Cardiology 07/2014; 37(7). DOI:10.1002/clc.22270 · 2.59 Impact Factor
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