Obesity and Age of First Non–ST-Segment Elevation Myocardial Infarction
Key result
Higher body mass index was strongly associated with premature first NSTEMI, occurring up to 12.0 years earlier in the most obese patients compared to normal-weight patients (p<0.0001).
Why the study?
Because excess adiposity is a key determinant of adipokines and inflammatory factors linked to coronary plaque rupture, the authors hypothesized obesity is associated with MI at earlier ages.
Key Points
- This research aims to understand how obesity influences the age at which individuals experience their first non-ST-segment elevation myocardial infarction.
- Examined a cohort of individuals who experienced non-ST-segment elevation myocardial infarction.
- Analyzed data on obesity and its association with the age of first myocardial infarction.
- Obesity is linked to an earlier age of first myocardial infarction compared to non-obese individuals.
- Findings suggest that individuals with obesity may encounter higher risks for cardiovascular events at younger ages.
Study Design
Type
Observational (n=111,847)
Multicenter
Yes
PICO
P
Population
111,847 patients with NSTEMI from the CRUSADE registry, analyzed retrospectively to assess the relationship between body mass index and age of first NSTEMI.
E
Exposure / Comparator
Higher body mass index (BMI) vs Normal weight (BMI 18.6 to 25.0 kg/m2)
O
Primary Outcome
Age of first NSTEMI — 12.0 years earlier, p=< 0.0001
Main Result
Mean Difference: -12
Absolute Event Rate: 58.7% vs 74.6%
p-value: p=< 0.0001
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Basically, it is showing that as people got progressively more obese, the rate at which they had heart attacks early went up dramatically.”
Implication
Randomized trial investigates how obesity affects the age of first myocardial infarction, suggesting important health implications.
Abstract
OBJECTIVES: Because excess adiposity is one of the most important determinants of adipokines and inflammatory factors associated with coronary plaque rupture, we hypothesized that obesity was associated with myocardial infarction at earlier ages. BACKGROUND: The developing obesity pandemic of the past 50 years has gained considerable attention as a major public health threat. METHODS: The CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) registry was a voluntary observational data collection and quality improvement initiative that began in November 2001, with retrospective data collection from January 2001 to January 2007. The CRUSADE initiative included high-risk patients with unstable angina and non-ST-segment elevation myocardial infarction (NSTEMI). We retrospectively examined, among 189,065 patients with acute coronary syndrome (between January 2001 and September 2006) in the CRUSADE initiative, the relationship of body mass index (BMI) with patient age of first NSTEMI. RESULTS: A total of 111,847 patients with NSTEMI were included in the final analysis. There was a strong, inverse linear relationship between BMI and earlier age of first NSTEMI. The mean patient ages (+/- SD) of first NSTEMI were 74.6 +/- 14.3 years and 58.7 +/- 12.5 years for the leanest (BMI <or=18.5 kg/m(2)) and most obese (BMI >40.0 kg/m(2)) cohorts, respectively (p < 0.0001). After adjustment for baseline demographic data, cardiac risk factors, and medications, the age of first NSTEMI occurred 3.5, 6.8, 9.4, and 12.0 years earlier with ascending levels of adiposity (BMI 25.1 to 30.0, 30.1 to 35.0, 35.1 to 40.0, and >40.0 kg/m(2), respectively; referent 18.6 to 25.0 kg/m(2)) (p < 0.0001 for each estimate). CONCLUSIONS: Excess adiposity is strongly related to first NSTEMI occurring prematurely.
Discussion
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Cite This Study
Madala et al. (2008) conducted an observational in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=111,847). Higher body mass index (BMI) vs. Normal weight (BMI 18.6 to 25.0 kg/m2) was evaluated on Age of first NSTEMI (12.0 years earlier, p=< 0.0001). Higher body mass index was strongly associated with premature first NSTEMI, occurring up to 12.0 years earlier in the most obese patients compared to normal-weight patients (p<0.0001).