Abstract 17701: Impact of Central Obesity on Long-term Cardiovascular Events in Younger Patients With ST-Elevation Myocardial Infarction
Background: The risk of cardiovascular complications, including recurrent myocardial infarction, sudden cardiac death, and stroke, for those who survived acute myocardial infarction is substantial even in the era of optimal reperfusion strategies. Previous studies have shown that high waist hip ratio (WHR) is associated with higher short-term mortality within 1 year after acute coronary syndrome. The relationship of central obesity and long-term clinical outcomes with respect to age after ST-elevation myocardial infarction (STEMI) remains to be elucidated.
Methods and Results: The study enrolled 458 patients (379 men) with STEMI who admitted to our hospital within 6 hours from symptom onset. All patients underwent coronary reperfusion therapy. Mean follow-up duration was 6.1±2.6 years. The major adverse cardiac and cerebrovascular events (MACCE) were defined as cardiac death, sudden death, non-fatal MI, unstable angina, and stroke. The study population was categorized by median WHR; high WHR group (≧0.95) and low WHR group (<0.95). Baseline characteristics including age, sex, BMI(body mass index) and peak creatin kinase level were similar between the groups. High WHR group had a higher frequency of diabetes mellitus (34% vs. 24%, p=0.025). MACCE occurred in 68 patients, including 7 cardiac deaths, 20 non-fatal MI, 24 unstable angina, and 17 stroke. In younger patients (age<65 years old), MACCE event occurred more frequently in the high WHR group as compared with low WHR group by Kaplan-Meier survival analysis (24% vs. 11%, p=0.035). Multivariable analysis revealed that high WHR (odds ratio(OR) 3.17, 95% confidence interval (CI) 1.26 to 7.98, p=0.014) was significantly predictive of MACCE independent of sex, BMI, and traditional cardiovascular risk factors. In older patients (age≧65 years old), Kaplan-Meier survival curve showed that there was no significant difference between high and low WHR groups in MACCE events (12% vs. 10%, p=0.46).
Conclusions: High WHR was associated with worse long-term prognosis in patients who survived STEMI. Strategies to ameliorate central obesity may improve long-term outcomes,especially in young patients.
- © 2013 by American Heart Association, Inc.