SPC365

The Obesity Paradox in Acute ST-elevated Myocardial Infarction

Session: Posters (Sessão 4 - Écran 6) - Doença Coronária e Cuidados Intensivos 5 - EAMcST
Speaker: Joana Laranjeira Correia

Congress: CPC 2022
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Joana Laranjeira Correia; Vanda Devesa Neto; João Miguel Santos; Gonçalo Ferreira; Inês Pires; José Costa Cabral; António Costa

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">Introduction: It is proposed that among patients with certain chronic diseases (including chronic kidney disease, chronic heart failure, or chronic obstructive pulmonary disease), those with overweight or obesity are associated with survival advantages. These paradoxical findings are known as the &ldquo;obesity paradox&rdquo;. This phenomenon has also been described in patients with coronary artery disease.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">Objective: The objective of this study is to evaluate the impact of obesity on the presentation, treatment and prognosis of patients hospitalized for ST-elevated Myocardial Infarction (STEMI). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">Methods: A retrospective study of patients admitted with a STEMI in the cardiology department of a tertiary centre was performed. Clinical, analytical, angiographic and sonographic parameters were evaluated on admission, as well as at 12-month follow-up. The patients were then divided into 2 groups: group A (GA) obese with a body mass index (BMI)&gt;= 30kg/m<sup>2</sup> and group B (GB) non-obese with a BMI &lt; 30kg/m<sup>2</sup>. SPSS statistical analysis was applied, with a p &lt;0.05 considered to be significant. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">Results: A total of 651 patients were evaluated, 73.9% male, age 66 &plusmn; 13 years, of which 18.7% were obese. No statistical difference was observed when comparing genders. However, when comparing ages, obese patients were predominantly younger (mean age 61.3</span></span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">&plusmn;12.8 </span><span style="background-color:white"><span style="color:black">years in GA vs 67.41</span></span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">&plusmn;13.4</span><span style="background-color:white"><span style="color:black"> years in GB, p &lt;0.001). &nbsp;&nbsp;Comparing GA and GB, there was an higher rate of hypertension (72.1% vs 55.8%, p = 0.001), dyslipidemia (48.4% vs 39.6%, p = 0.048), diabetes mellitus (36.1% vs 19.1%, p &lt;0.001) and obstructive lung disease (11.1% vs 4.5%, p = 0.017) in the first group. No statistical differences were found when evaluating previous medication and therapy instituted during hospitalization. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">Statistical differences were observed when comparing hemoglobin levels (mean 14.7&plusmn;1.8 g/dl vs 14.1&plusmn;1.8 g/dl, p &lt;0.001) and triglycerides (152&plusmn;99.8 mg/dl vs. 126&plusmn;99.3 mg/dl, p = 0.014), being higher in GA, while HDL cholesterol levels (38&plusmn;10.9 mg/dL vs 41&plusmn;11.0 mg/dL p = 0.045) were lower in GA. There was a higher left ventricular ejection fraction (LVEF) in the obese group (58&plusmn;10.9% vs 52&plusmn;12.2%, p &lt;0.001). &nbsp;No difference in in-hospital mortality rate (8.2% vs 9.0%, p = 0.470) was observed. There was lower mortality in obese patients after 1 year of follow-up (1.0% vs 5.4%, Kaplan-Meier log-rank 0.030). After multivariate analysis, it appears that differences in mortality are dependent on LVEF. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">Conclusion: Evidence suggests that obesity is closely related to cardiovascular disease. However, the Obesity Paradox has been described in many diseases, including coronary heart disease. In this study population, although obesity is significantly associated with other cardiovascular risk factors, it seems to act as a protective factor in STEMI patients. This is confirmed with a lower mortality rate after 1-year follow-up.</span></span></span></span></p>