Author + information
- Jose Medina,
- John Batsis,
- Marta Supervia,
- Virend Somers,
- Randal Thomas,
- Sarah Jenkins and
- Francisco Lopez-Jimenez
Background: Central obesity leads to increased cardiovascular events. However, it is unknown whether the same occurs in individuals with established coronary artery disease (CAD). We ascertained whether patients with established CAD and central obesity, as defined as an elevated waist-to-hip ratio (WHR), have an increased risk of major adverse cardiovascular events (MACE) than patients without central obesity.
Methods: We included consecutive patients referred to cardiac rehabilitation because of prior CAD events or procedures between the years 2002 and 2012 with complete clinical and WHR data. All follow-up was ascertained using the Rochester Epidemiology Project in Olmsted County, a population-based, record linkage system. Patients were classified in sex-specific tertiles of WHR (low tertile=referent). We defined MACE as a composite outcome of an acute coronary syndrome (myocardial infarction or unstable angina), coronary revascularization (coronary artery bypass grafting or percutaneous coronary intervention), ventricular arrhythmias, stroke or death from any cause. Sex-specific Cox proportional hazard models were adjusted for age, smoking and history of heart failure.
Results: We included 1529 patients (74% males) with mean age ± SD of 63.1±12.5 years. Mean BMI was 29.9±5.5 kg/m2 and 28.9±6.1 kg/m2 for males and females, respectively (p=0.005) and mean WHR was 0.98±0.08 cm for men and 0.86 ±0.08 for females (p<0.001). Eighty-eight percent of males and 57% of females were classified as having central obesity (p<0.001). Median follow-up was 5.7 years and 415 patients had an event. BMI did not predict MACE (HR=1.01 95% CI: 0.98,1.04; p=0.41 for females; HR 0.99 95% CI: 0.97,1.01;p=0.56 for males). After adjustment, a high WHR tertile remained a significant predictor for MACE for females (overall p-value= 0.007), but not for males (p=0.12). Adjusted MACE risk for females (HR=1.85 95% CI: 1.16,2.94; p=0.01). This relationship persisted after further adjustment by BMI (HR=1.75 95% CI: 1.07,2.87; p=0.03), while BMI continued unrelated to MACE after adjusting for potential confounders.
Conclusions: WHR is associated with a higher risk of MACE among females but not in males with CAD.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Predicting Outcomes in Cardiac Rehabiltation Patients
Abstract Category: 34. Prevention: Rehabilitation
Presentation Number: 1276-039
- 2017 American College of Cardiology Foundation