Key result
Obesity was associated with less anatomically obstructive CAD (65.2% vs 73.2% normal BMI; P<0.001) but similar rates of physiologically significant CAD and major adverse cardiovascular events (P>0.05).
Why the study?
The relationship between body size and cardiovascular events is complex, motivating an investigation into the association between BMI, CAD, and clinical outcomes.
Does obesity affect the risk of major adverse cardiovascular events and the physiological significance of CAD in patients with suspected CAD and >30% stenosis on CCTA?
Observational (n=5,014)
Does obesity affect the risk of major adverse cardiovascular events and the physiological significance of CAD in patients with suspected CAD and >30% stenosis on CCTA?
p-value: p=>0.05
In patients with suspected CAD, obesity is associated with less anatomically obstructive disease but similar physiologically significant disease and adverse event rates compared to normal BMI, suggesting anatomic assessment alone may underestimate risk in obese patients.
Obesity-associated milder CAD and outcomes in suspected cases; leaves open BMI-adjusted FFRCT thresholds or risk models.
Background: The relationship between body size and cardiovascular events is complex. This study utilized the ADVANCE (Assessing Diagnostic Value of Noninvasive FFR CT in Coronary Care) Registry to investigate the association between body mass index (BMI), coronary artery disease (CAD), and clinical outcomes. Methods: The ADVANCE registry enrolled patients undergoing evaluation for clinically suspected CAD who had >30% stenosis on cardiac computed tomography angiography. Patients were stratified by BMI: normal <25 kg/m 2 , overweight 25–29.9 kg/m 2 , and obese ≥30 kg/m 2 . Baseline characteristics, cardiac computed tomography angiography and computed tomography fractional flow reserve (FFR CT ), were compared across BMI groups. Adjusted Cox proportional hazards models assessed the association between BMI and outcomes. Results: Among 5014 patients, 2166 (43.2%) had a normal BMI, 1883 (37.6%) were overweight, and 965 (19.2%) were obese. Patients with obesity were younger and more likely to have comorbidities, including diabetes and hypertension (all P <0.001), but were less likely to have obstructive coronary stenosis (65.2% obese, 72.2% overweight, and 73.2% normal BMI; P <0.001). However, the rate of hemodynamic significance, as indicated by a positive FFR CT , was similar across BMI categories (63.4% obese, 66.1% overweight, and 67.8% normal BMI; P =0.07). Additionally, patients with obesity had a lower coronary volume-to-myocardial mass ratio compared with patients who were overweight or had normal BMI (obese BMI, 23.7; overweight BMI, 24.8; and normal BMI, 26.3; P <0.001). After adjustment, the risk of major adverse cardiovascular events was similar regardless of BMI (all P >0.05). Conclusions: Patients with obesity in the ADVANCE registry were less likely to have anatomically obstructive CAD by cardiac computed tomography angiography but had a similar degree of physiologically significant CAD by FFR CT and similar rates of adverse events. An exclusively anatomic assessment of CAD in patients with obesity may underestimate the burden of physiologically significant disease that is potentially due to a significantly lower volume-to-myocardial mass ratio.
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Lowenstern et al. (2023) conducted an observational in Clinically suspected coronary artery disease (n=5,014). Obesity (BMI ≥30 kg/m2) vs. Normal BMI (<25 kg/m2) and overweight (25-29.9 kg/m2) was evaluated on Major adverse cardiovascular events (p=>0.05). Obesity was associated with less anatomically obstructive CAD (65.2% vs 73.2% normal BMI; P<0.001) but similar rates of physiologically significant CAD and major adverse cardiovascular events (P>0.05).
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