Abstract 11989: The Impact of Inflammation/ CRP and Body Fat on Mortality in Coronary Heart Disease -A New Twist in the “Obesity Paradox”
Background: Despite the well-known adverse effects of obesity on almost all aspects of coronary heart disease (CHD), many studies of CHD cohorts have demonstrated an inverse relationship between obesity and subsequent prognosis (the “obesity paradox”). The etiology of this paradox and the potential role of inflammation in this process remain unknown.
Patients and Methods: We studied 513 patients with CHD following major CHD events, who were divided into low (≤ 25% men and ≤ 35% women) and high body fat (BF;> 25% in men and > 35% in women) as determined by the sum of the skin-fold method. Similarly, they were divided into low (≤3.0 mg/L) and high (>3mg/L) inflammatory states based on high-sensitivity C reactive peptide (CRP). Four groups were analyzed by total mortality over 3-year follow-up by National Death Index: Low BF/Low CRP (n=160), High BF/Low CRP (n=201), Low BF/High CRP (n=55) and High BF/High CRP (n=97).
Results: During 3-year follow-up, all-cause mortality was highest in the Low BF/High CRP group (15%), which was significantly (p<0.0001) higher than the other 3 groups (2.1% for the High BF/High CRP, 3.5% for the High BF/Low CRP, and 4.4% for the Low Fat/Low CRP, respectively-Figure). Using a proportional hazard model, after adjusting for BF, age, gender, ejection fraction and peak oxygen consumption,both low BF (HR 0.907, CI 0.849-0.969 ) and high CRP were associated with higher mortality (HR 2.78, CI 1.14 - 6.76).
Conclusions: Although low BF and high CRP are independent predictors of mortality in patients with CHD, those patients with combined low BF and high inflammatory state appear to be at particularly high risk for mortality. Obese patients with high inflammation, on the other hand, do not seem to share the same high mortality risk.Figure. Kaplan Meier Survival curve over 3-year follow-up by National Death Index: Low BF/Low CRP (n=160), High BF/Low CRP (n=201), Low BF/High CRP (n=55) and High BF/High CRP (n=97)
- © 2011 by American Heart Association, Inc.