This article is more than 5 years old. Information may no longer be current.
Coronary microvascular dysfunction confers adverse outcomes, elevated BMI
Click Here to Manage Email Alerts
Coronary microvascular dysfunction was independently associated with adverse outcomes and elevated BMI in patients who underwent evaluation for CAD, according to a study published in the Journal of the American College of Cardiology.
PET myocardial perfusion imaging
Navkaranbir S. Bajaj, MD, MPH, clinical fellow in radiology at Brigham and Women’s Hospital, and colleagues analyzed data from 827 patients (median age, 62 years; 70% women; median BMI, 29.6 kg/m2) who underwent PET myocardial perfusion imaging to evaluate for suspected CAD between 2007 and 2014. Patients were excluded if they met criteria such as known CAD, history of severe valvular disease or HF, kidney disease or PET evidence of flow-limiting CAD.
Clinical symptoms that led to the evaluation included dyspnea, chest pain or a combination. Information collected during PET imaging included BMI, patient history, select laboratory values and medication use.
Patients with obesity (n = 398) were categorized by whether they were recommended (n = 233) or not recommended (n = 165) for bariatric surgery, which was defined by guidelines from the American Association of Clinical Endocrinologists, the Obesity Society and the American Society for Metabolic and Bariatric Surgery.
The outcome of interest was the first major adverse event, which included a composite of death or hospitalization for HF or MI.
Higher BMI was independently linked to lower coronary flow reserve, as shown by an inverted J curve with an inflexion point at a BMI greater than 30 kg/m2 (P < .0001).
Coronary flow reserve
After adjustment, coronary flow reserve was independently associated with events (HR for 1-U decrease in coronary flow reserve = 1.95; 95% CI, 1.41-2.69), although this was not seen for BMI (HR for 10-U increase in BMI = 1.2; 95% CI, 0.95-1.5). Further incremental improvements in model statistics were seen when coronary flow reserve was added into the Cox proportional hazard model with BMI (C-index = 0.71-0.74).
Patients with obesity and impaired coronary flow reserve had a higher adjusted annualized rate of adverse events compared with those whose coronary flow reserve was not impaired (5.7% vs. 2.6%; P = .002 for all). This was also seen in patients who did not meet indications for bariatric surgery (6.4% vs. 2.6%; P = .04).
“Prospective studies are needed to investigate a possible role for the use of [coronary flow reserve] as a marker of vascular health in the risk management of obese patients beyond BMI and traditional risk factors,” Bajaj and colleagues wrote.
“It appears advisable that, apart from primary preventive medical care to control for cardiovascular risk factors, treatment strategies should always imply weight reduction and continuous physical exercise in obese individuals, independent of the presence or absence of coronary microvascular dysfunction,” Thomas H. Schindler, MD, associate professor of radiology at Washington University School of Medicine in St. Louis, wrote in a related editorial. – by Darlene Dobkowski
Disclosures: This work was supported in part by Gilead Sciences Research Scholars Program in Cardiovascular Disease. Bajaj and Schindler report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts