Progression of Subclinical Coronary Atherosclerosis Does Obesity Make a Difference?
Department of Epidemiology, University of Michigan, 611 Church St, Ann Arbor, MI 48104-3028, USA. Circulation
(Impact Factor: 14.43).
04/2005; 111(15):1877-82. DOI: 10.1161/01.CIR.0000161820.40494.5D
Obesity is associated with coronary artery calcification (CAC), a marker of the presence and extent of subclinical coronary atherosclerosis. Obesity adds incremental information in identifying those at higher risk of coronary heart disease to traditional risk factor assessment. The present study examined associations between obesity measures and progression of CAC in those at higher (> or =10%) and lower (<10%) 10-year coronary heart disease risk according to the Framingham risk equation.
In this study, 443 asymptomatic white individuals >30 years of age (243 men) had baseline and follow-up CAC measurements an average of 8.9 years apart. Multivariable linear regression models were fit to determine associations of obesity measures at baseline with progression of CAC defined as log(e) of the difference between follow-up and baseline CAC area plus 1 divided by time (in years) between examinations, adjusting for baseline CAC quantity, age, sex, baseline hypertension status, and baseline cholesterol level. Among 329 participants (74.3%) in the lower-risk group, waist circumference (P=0.024), waist-to-hip ratio (P<0.001), body mass index (P=0.036), and being overweight compared with being underweight or of normal weight (P=0.008) were each significantly positively associated with progression of CAC. Among those at higher coronary heart disease risk, no baseline obesity measures were associated with CAC progression.
Various measures of obesity were associated with increased progression of CAC in those at lower risk of coronary heart disease. Future studies examining the effectiveness of weight reduction strategies in reducing CAC progression among those with an otherwise favorable risk factor profile may be warranted.
Available from: Barry A Franklin
- "Abdominal obesity and/or an elevated BMI are associated with an increased prevalence of CAC and progression of subclinical coronary atherosclerosis.16,17 In turn, the CAC burden is widely considered to be a marker of atherosclerosis and a risk factor for the development of future cardiac events.18 "
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ABSTRACT: Obesity is a common public health problem and obese individuals in particular have a disproportionate incidence of acute coronary events. This study was undertaken to identify coronary artery lesions as well as associated clinical features, risk factors and demographics in patients with a body mass index (BMI) >40 kg/m(2) without known coronary artery disease (CAD). Morbidly obese subjects were prospectively recruited to undergo coronary computed tomographic angiography (CCTA) using a dual-source computed tomography (CT) system. CAD was defined as the presence of any atherosclerotic lesion in any one coronary artery segment. The presence, location, and severity of atherosclerosis were related to patient characteristics. Forty-one patients (28 women, mean age, 50.4±10.0 years, mean BMI, 43.8±4.8 kg/m(2)) served as the study population. Of these, 25 patients (61%) had at least one coronary stenosis. All but 2 patients within the CAD cohort had coronary artery calcium (CAC) scores >0, and most plaques identified (75.4%) were non-calcified. There was a predilection of calcified and non-calcified atherosclerosis involving the left anterior descending (LAD) coronary artery compared with other coronary segments. Univariate predictors of CAD included older age, dyslipidemia, and diabetes. In this preliminary study of young morbidly obese patients, CCTA detected a high prevalence of calcified and non-calcified CAD, although the later predominated.
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ABSTRACT: To evaluate the cardiometabolic risk profiles of 6938 women (mean age 49.2 +/- 14.6 years) attending the 2005 Sister to Sister: Everyone Has a Heart Foundation free public health standardized cardiovascular disease (CVD) risk factor screening events in 12 cities across the United States by race/ethnicity and waist circumference.
Among women without a history of CVD or diabetes (n = 6327), 90% were found to have at least one major modifiable CVD risk factor, with one-third of women having three or more major risk factors. Nearly half of all women with elevated total cholesterol (> or = 200 mg/dL) or low high-density lipoprotein (HDL)-cholesterol (< 50 mg/dL) did not report a known history of abnormal cholesterol. Among women with no history of hypertension, 16% had a blood pressure > or = 140/90 mm Hg. Unrecognized diabetes and glucose intolerance were striking among fasting women (n = 1218; 9% had a blood glucose > or = 126 mg/dL and 43% had a blood glucose > or = 100 mg/dL). In adjusted logistic regression models, women with a waist circumference > or = 35 inches were more likely to have blood pressure > or = 140/90 (OR = 1.9, p < 0.0001), total cholesterol > or = 200 mg/dL (OR = 1.2, p = 0.006), HDL-cholesterol < 50 mg/dL (OR = 2.5, p < 0.0001), fasting glucose > or = 100 mg/dL (OR = 2.0, p < 0.0001), and Framingham global risk score > or = 10%, CVD or diabetes (OR = 2.0, p < 0.0001). Waist circumference was significantly correlated with Framingham global risk (r = 0.24, p < 0.001) and number of risk factors (r = 0.24, p < 0.0001). Increased clustering of risk factors was predictive of waist size > or = 35 inches vs. < 35 inches in logistic models (p for trend > 0.0001). Among a subsample of women who underwent standardized screening for stress and depression, 62% had stress levels associated with increased cardiac risk, and 27% met criteria for clinical depression.
Hypertension, dyslipidemia, and/or impaired fasting glucose were newly identified in approximately half the women screened. Waist size significantly correlated with clustering of risk factors, global Framingham risk score, CVD and diabetes, suggesting it may be an easily measured surrogate for women at increased risk of future cardiovascular clinical events who may benefit from further assessment and intervention.
Available from: Charlotte Brown
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ABSTRACT: Emerging evidence suggests that exposure to discrimination may be associated with atherosclerosis in African-American women, although research in this area focused on short-term rather than chronic exposure to discriminatory events.
We examined the relationship between chronic exposure to multiple types of discrimination (self-reported and averaged over 5 years) and coronary artery calcification (CAC) in a sample of 181 middle-aged African-American women. Discrimination was assessed at each time point, and the presence/absence of CAC was assessed at the fifth annual follow-up examination by electron beam tomography. We hypothesized that chronic discrimination would be more strongly associated with CAC than recent discrimination and that racial/ethnic discrimination would be more strongly associated with CAC than other types of discrimination.
Chronic exposure to discrimination was significantly associated with the presence of CAC in unadjusted logistic regression analyses (p = .007) and after adjustment for demographics (p = .01), standard cardiovascular risk factors (p = .02), and Body Mass Index (BMI) (p = .05). In contrast, recent discrimination was only marginally associated with the presence of CAC in both unadjusted (p = .06) and fully adjusted logistic regression models (p = .08). Persistent exposure to racial/ethnic discrimination was not more strongly associated with CAC compared with other types of discrimination in either unadjusted or adjusted models.
Chronic exposure to discrimination may be an important risk factor for early coronary calcification in African-American women. This association appears to be driven by exposure to discrimination from multiple sources, rather than exposure to racial/ethnic discrimination alone.
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