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The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative.
Am Heart J 2006; 152(1):140-8AH

Abstract

BACKGROUND

Although obesity is a known risk factor for coronary artery disease, its impact on the presentation, treatment, and outcome of patients with acute coronary syndromes (ACS) has not been well studied.

METHODS

Using data from the CRUSADE Initiative, we compared inhospital treatments and clinical outcomes of 80845 patients with high-risk non-ST-segment elevation (NSTE) ACS (positive cardiac markers and/or ischemic ST-segment changes) to determine whether there was an association with body mass index (BMI [kg/m2]). Patient weights were categorized according to World Health Organization classifications: Underweight (BMI <18.5), Normal range (BMI 18.5-24.9), Overweight (BMI 25-29.9), Obese Class I (BMI 30-34.9), Obese Class II (BMI 35-39.9), and Extremely Obese (BMI =40).

RESULTS

Most (70.5%) of the CRUSADE patients were classified as overweight or obese; these patients were younger and more likely to present with comorbid conditions, including diabetes mellitus, hypertension, and hyperlipidemia. Medications given during the first 24 hours and invasive cardiac procedures recommended by the American College of Cardiology/American Heart Association guidelines for NSTE ACS were more commonly used in these patients. The incidence of death and death and reinfarction, adjusted for covariates, were generally lower in overweight and obese patients, compared with normal-weight patients, but higher in underweight and extremely obese patients.

CONCLUSIONS

Most patients with NSTE ACS are overweight or obese. These patients receive more aggressive treatment, and, except for the extremely obese, have less adverse outcomes compared with underweight and normal-weight patients. Although obesity appears to be a risk factor for developing ACS at a younger age, it also appears to be associated with more aggressive ACS management and, ultimately, improved outcomes.

Authors+Show Affiliations

Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA, USA. dbdiercks@ucdavis.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16824844

Citation

Diercks, Deborah B., et al. "The Obesity Paradox in non-ST-segment Elevation Acute Coronary Syndromes: Results From the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative." American Heart Journal, vol. 152, no. 1, 2006, pp. 140-8.
Diercks DB, Roe MT, Mulgund J, et al. The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative. Am Heart J. 2006;152(1):140-8.
Diercks, D. B., Roe, M. T., Mulgund, J., Pollack, C. V., Kirk, J. D., Gibler, W. B., ... Peterson, E. D. (2006). The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative. American Heart Journal, 152(1), pp. 140-8.
Diercks DB, et al. The Obesity Paradox in non-ST-segment Elevation Acute Coronary Syndromes: Results From the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative. Am Heart J. 2006;152(1):140-8. PubMed PMID: 16824844.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative. AU - Diercks,Deborah B, AU - Roe,Matthew T, AU - Mulgund,Jyotsna, AU - Pollack,Charles V,Jr AU - Kirk,J Douglas, AU - Gibler,W Brian, AU - Ohman,E Magnus, AU - Smith,Sidney C,Jr AU - Boden,William E, AU - Peterson,Eric D, PY - 2005/04/20/received PY - 2005/09/30/accepted PY - 2006/7/11/pubmed PY - 2006/8/24/medline PY - 2006/7/11/entrez SP - 140 EP - 8 JF - American heart journal JO - Am. Heart J. VL - 152 IS - 1 N2 - BACKGROUND: Although obesity is a known risk factor for coronary artery disease, its impact on the presentation, treatment, and outcome of patients with acute coronary syndromes (ACS) has not been well studied. METHODS: Using data from the CRUSADE Initiative, we compared inhospital treatments and clinical outcomes of 80845 patients with high-risk non-ST-segment elevation (NSTE) ACS (positive cardiac markers and/or ischemic ST-segment changes) to determine whether there was an association with body mass index (BMI [kg/m2]). Patient weights were categorized according to World Health Organization classifications: Underweight (BMI <18.5), Normal range (BMI 18.5-24.9), Overweight (BMI 25-29.9), Obese Class I (BMI 30-34.9), Obese Class II (BMI 35-39.9), and Extremely Obese (BMI =40). RESULTS: Most (70.5%) of the CRUSADE patients were classified as overweight or obese; these patients were younger and more likely to present with comorbid conditions, including diabetes mellitus, hypertension, and hyperlipidemia. Medications given during the first 24 hours and invasive cardiac procedures recommended by the American College of Cardiology/American Heart Association guidelines for NSTE ACS were more commonly used in these patients. The incidence of death and death and reinfarction, adjusted for covariates, were generally lower in overweight and obese patients, compared with normal-weight patients, but higher in underweight and extremely obese patients. CONCLUSIONS: Most patients with NSTE ACS are overweight or obese. These patients receive more aggressive treatment, and, except for the extremely obese, have less adverse outcomes compared with underweight and normal-weight patients. Although obesity appears to be a risk factor for developing ACS at a younger age, it also appears to be associated with more aggressive ACS management and, ultimately, improved outcomes. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/16824844/The_obesity_paradox_in_non_ST_segment_elevation_acute_coronary_syndromes:_results_from_the_Can_Rapid_risk_stratification_of_Unstable_angina_patients_Suppress_ADverse_outcomes_with_Early_implementation_of_the_American_College_of_Cardiology/American_Heart_Association_Guidelines_Quality_Improvement_Initiative_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(05)00937-3 DB - PRIME DP - Unbound Medicine ER -