Obesity, metabolic syndrome and cardiovascular prognosis: from the Partners coronary computed tomography angiography registry

Edward A. Hulten, Marcio Sommer Bittencourt, Ryan Preston, Avinainder Singh, Carla Romagnolli, Brian Ghoshhajra, Ravi Shah, Siddique Abbasi, Suhny Abbara, Khurram Nasir, Michael Blaha, Udo Hoffmann, Marcelo F. Di Carli, Ron Blankstein

To investigate the relationship among body mass index (BMI), cardiometabolic risk and coronary artery disease (CAD) among patients undergoing coronary computed tomography angiography (CTA). Retrospective cohort study of 1118 patients, who underwent coronary CTA at two centers from September 2004 to October 2011. Coronary CTA were categorized as normal, nonobstructive CAD (<50%), or obstructive CAD (≥50%) in addition to segment involvement (SIS) and stenosis scores. Extensive CAD was defined as SIS > 4. Association of BMI with cardiovascular prognosis was evaluated using multivariable fractional polynomial models. Mean age of the cohort was 57 ± 13 years with median follow-up of 3.2 years. Increasing BMI was associated with MetS (OR 1.28 per 1 kg/m(2), p < 0.001) and burden of CAD on a univariable basis, but not after multivariable adjustment. Prognosis demonstrated a J-shaped relationship with BMI. For BMI from 20-39.9 kg/m(2), after adjustment for age, gender, and smoking, MetS (HR 2.23, p = 0.009) was more strongly associated with adverse events. Compared to normal BMI, there was an increased burden of CAD for BMI > 25 kg/m(2). Within each BMI category, metabolically unhealthy patients had greater extent of CAD, as measured by CCTA, compared to metabolically healthy patients.