Author + information
- Sheldon E. Litwina,b,
- Adrian Colesa,b,
- Neha Pagidipatia,b,
- Kerry Leea,b,
- Patricia Pellikkaa,b,
- Daniel Marka,b,
- James Udelsona,b,
- Lawton Coopera,b,
- Jean Claude Tardifa,b,
- Randy Cohena,b,
- Udo Hoffmanna,b and
- Pamela Douglasa,b
Background: Obesity is common in patients with suspected CAD, but may confound the accurate prediction of CV risk.
Methods: We compared risk factors, risk scores, physician's perception of risk, and outcomes in PROMISE trial patients (n= 10,003) by BMI. Cox regression tested associations between BMI and composite endpoints of death, CV death, unstable angina hospitalization and MI (adjusted for covariates).
Results: BMI was ≥ 30 kg/m2 in 48% and ≥ 35 in 20%. Increasingly obese patients tended to be younger and nonsmoking, with higher prevalences of hypertension, diabetes, black race and sedentary lifestyle. Diamond-Forrester (DF) risk of obstructive CAD had an inverted U-shaped relationship with BMI while physicians’ estimates of CAD likelihood increased with BMI. Correlation between DF score and physician assessment was low (r=0.28). Framingham Risk Score (FRS) showed increasing risk with higher BMI with a plateau above BMI=35 (Figure). In contrast, there was a strong and consistent inverse relationship between obesity and both composite clinical endpoints over 25 months of f/u.
Conclusions: In contemporary populations with suspected CAD, obesity is associated with differences in risk factor burden, and pretest risk assessments. Despite treating physicians’ perceptions of increasing risk with increasing BMI, DF and FRS do not predict highest risk in the most obese. Further, increasingly obese patients had fewer adverse outcomes, suggesting a need for updated risk assessment approaches.
Moderated Poster Contributions
Acute and Stable Ischemic Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 1:00 p.m.-1:10 p.m.
Session Title: New Perspectives on CAD Risk Factors
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1319M-07
- 2017 American College of Cardiology Foundation