ClinicalBiomarker evaluation as a potential cause of gender differences in obesity paradox among patients with STEMI☆
Introduction
Obesity is a serious public health care problem in industrialized nations with growing prevalence [1]. In overweight patients the risk of all-cause mortality is markedly increased over all age groups in men and women [2], [3], [4]. As a well-established risk factor for developing diabetes and hypertension, obesity has a substantial impact on cardiovascular diseases and mortality [2], [4], [5]. Dyslipidemia is caused by obesity and especially the combination of low high-density lipoprotein cholesterol (HDL-c) and high low-density lipoprotein cholesterol (LDL-c) levels as well as elevated triglyceride levels are a predictor for cardiovascular events [3], [6].
Surprisingly several previously published studies indicated, that mild obesity has a protective role in patients with obstructive lung disease, end-stage renal disease, advanced cancer as well as in several cardiovascular disorders [3], [7], [8], [9], [10]. Thus it is discussed that even patients with acute myocardial infarction might benefit from mild obesity [11], [12]. In the literature there are only a few studies focusing on gender differences in the “obesity paradox” achieving inconsistent results [13], [14]. There are indications that overweight women may have a decreased risk for acute myocardial infarction, whereas their male counterparts have an increased risk [15].
The purpose of the present study was to investigate gender related differences and the influence of different biomarkers reflecting the nutritional status and body mass index (BMI) on in-hospital major adverse cardiac events (MACE) in patients with ST-elevation myocardial infarction (STEMI).
Section snippets
Study design and patient population
We retrospectively evaluated during January 2002 to December 2013 803 patients with STEMI undergoing primary emergency percutaneous coronary intervention (PCI). The criteria for STEMI, identified in 12-lead electrocardiogram, were ST-elevation > 0.1 mV in two consecutively standard leads or ST-elevation at the J point > 0.2 mV in men and > 1.5 mV in women in two consecutively precordial leads, typical angina > 20 min or new left bundle branch block according to the AHA/ACC/ESC guidelines [16].
Clinical characteristics and laboratory data of the study cohort
The final study population consisted of 529 patients with a mean age of 61.4 ± 13.5 years, the majority of the patients being male (72.6%). The female group was significantly older (65.9 ± 14.4 vs. 59.7 ± 12.7 years; p < 0.0001) with a higher incidence of hypertension (52.9% vs. 70.3%; p = 0.0003). Diabetes mellitus as a CVRF showed no significant difference and contributed equally in both groups (male: 25.0% vs. female: 20.7%; p = 0.36), whereas smokers were more common in the male group (male: 60.9% vs.
Discussion
The WHO Global status report on Noncommunicable Diseases 2014 revealed the frightening data that nearly 1.9 billion adults worldwide were overweight (BMI 25.1–30.0 kg/m2) and over 600 million obese (BMI ≥ 30.1 kg/m2). Obesity with its growing prevalence has a substantial impact on the social health care system with sharply increasing mortality rates.
Calle et al. showed in 1999 that healthy subjects with no smoking history and all-cause mortality were the lowest at the BMI group 23.5–24.9 kg/m2 for
Conclusion
In patients with STEMI, patients with a BMI of 30.0–34.9 kg/m2 have a decreased risk for in-hospital MACE compared to patients with a normal BMI. There were no differences between men and women in the incidence of in-hospital MACE. While BMI could be identified as an independent predictor for in-hospital MACE, decreased HDL-c and elevated LDL-c where not independently associated with MACE.
Acknowledgements
This study is supported by the DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung — German Centre for Cardiovascular Research) and by the BMBF (German Ministry of Education and Research).
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Disclosures: All authors declare that there is no conflict of interest.
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The first two authors contributed equally.