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on October 13, 2003

Circulation. 2003
Published online before print October 13, 2003, doi: 10.1161/01.CIR.0000095270.85646.E8
A more recent version of this article appeared on November 4, 2003
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Submitted on January 13, 2003
Revised on August 8, 2003
Accepted on August 13, 2003

Body Mass Index. A Risk Factor for Unstable Angina and Myocardial Infarction in Patients With Angiographically Confirmed Coronary Artery Disease

Robert Wolk MD, PhD, Peter Berger MD, Ryan J. Lennon MS, Emmanouil S. Brilakis MD, and Virend K. Somers MD, PhD*

From the Division of Cardiovascular Diseases (R.W., P.B., E.S.B., V.K.S.), the Division of Hypertension (R.W., V.K.S.), and the Division of Biostatistics (R.J.L.), Mayo Clinic, Rochester, Minn.

* To whom correspondence should be addressed. E-mail: somers.virend{at}mayo.edu.

Background--In patients with coronary artery disease (CAD), acute thrombosis frequently occurs in coronary arteries with only mild or moderate stenoses. Obesity increases the risk of atherosclerosis, but it is not known whether it also increases the risk of coronary thrombosis. We hypothesized that body mass index (BMI) might be an independent predictor of an acute coronary syndrome in patients with established coronary atherosclerosis.

Methods and Results--Of 504 patients undergoing coronary angiography, those with evidence of >10% coronary artery stenoses were divided into 2 groups, with either stable (n=226) or unstable CAD (unstable angina or myocardial infarction; n=156). After adjusting for other risk factors (age, gender, blood pressure, lipid levels, insulin resistance, leptin, fibrinogen, C-reactive protein (CRP), CAD severity on angiography, smoking status, and a history of myocardial infarction or hypertension), BMI had a significant independent association with an acute coronary syndrome, with an odds ratio of 1.49 (P=0.014). This positive relation between BMI and the risk of acute coronary events was evident for even mildly elevated BMI values. Multivariate analysis also showed that CRP and the number of coronary lesions were independent predictors of risk of an acute coronary event.

Conclusions--In patients with established coronary atherosclerosis, BMI, as well as CRP and number of coronary lesions, are independently associated with acute coronary syndromes. There is evidence of increased risk even at mildly elevated BMI levels.
Key words: obesity • coronary disease • atherosclerosis • angiography




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