Abdominal obesity and ten-year prognosis of patients with myocardial infarction

Aim. To assess the relationship of abdominal obesity with left ventricular systolic function and to predict outcomes in patients with MI within 10 years.
Methods. 581 medical records of patients enrolled in the Acute coronary Syndrome Registry between 2008 and 2010 were retrospectively reviewed for the period of 10 years. The following clinical endpoints were collected: all-cause mortality, cardiovascular mortality, recurrent myocardial infarction, stroke, hospitalization due to unstable angina and decompensated heart failure. Baseline left ventricular ejection fraction (LVEF) and the presence of abdominal obesity measured as waist-to-hip ratio were collected in all patients.
Results. Abdominal obesity was found in 392 (67.4%) patients admitted with MI. The presence of abdominal obesity did not affect main outcomes within 10 years after the indexed event. Cardiovascular mortality was the lowest among patients with abdominal obesity., an association between abdominal obesity and low cardiovascular mortality was found in patients with intermediate LVEF using the risk stratification data based on the severity of systolic dysfunction at discharge. The highest rate of recurrent hospitalization due to unstable angina was found in patients with abdominal obesity and intermediate LVEF.
Conclusion. The prevalence of abdominal obesity in MI patients was high (67%). Abdominal obesity appeared to confer protective effects on the 10-year clinical outcomes in patients with low and intermediate LVEF based on all-cause and cardiovascular mortality. The waist-to-hip ratio were significant in the generation of 10-year allcause and cardiovascular disease mortality prediction models in patients with MI.

1. World Health Organization — WHO (2017) Obesity and overweight. Controlling the global obesity epidemic. (Electronic resource). URL: http://www.who.int/nutrition/topics/obesity/en (access date: 13.05.2020).

2. Despres J. Body Fat Distribution and Risk of Cardiovascular Disease: An Update. Circulation. 2012; 126: 1301-13. doi: 10.1161/CIRCULATIONAHA.111.067264.

3. Coutinho T., Goel K., Correa de Sa. D., Kragelund C., Kanaya A.M., Zeller M., Park J.S., Kober L., Torp-Pedersen C., Cottin Y., Lorgis L., Lee S.H., Kim Y.J., Thomas R., Roger V.L., Somers V.K., Lopez-Jimenez F. Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data. J Am Coll Cardiol. 2011; 57: 1877-86. doi: 10.1016/j.jacc.2010.11.058.

4. Yusuf S., Hawken S., Ounpuu S., Bautista L., Franzosi M.G., Commerford P., Lang C.C., Rumboldt Z., Onen C.L., Lisheng L., Tanomsup S., Wangai P. Jr., Razak F., Sharma A.M., Anand S.S.; INTERHEART Study Investigators. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005; 366: 1640-9. doi: 10.1016/S0140-6736(05)67663-5.

5. Domanski M., Jablonski K., Rice M., Fowler S.E., Braunwald E.; PEACE Investigators. Obesity and cardiovascullar events in patients with established coronary disease. European Heart Journal. 2006. 27(12): 1416-1422. doi: 10.1093/eurheartj/ehl022.

6. Mathieu P., Poirier P., Pibarot P. Visceral obesity: the link among inflammation, hypertension, and cardiovascular disease. Hypertension. 2009; 53: 577-84. doi: 10.1161/HYPERTENSIONAHA.108.110320.

7. Sun K., Kusminski C., Scherer P. Adipose tissue remodeling and obesity. J Clin Invest. 2011; 121(6): 2094-101. doi: 10.1172/JCI45887.

8. Chumakova G.A., Veselovskaya N.G., Kozarenko A.A. Heart morphology, structure, and function in obesity. Russ J Cardiol. 2012, 4(17): 93-9. (in Russian)

9. Diagnostika, lechenie, profilaktika ozhirenija i associirovannyh s nim zabolevanij (nacional'nye klinicheskie rekomendacii). Pod red. Shljahto E.V., Nedogoda S.V., Konradi A.O. Sankt-Peterburg; 2017. (in Russian)

10. СSimonova GI, Mustafina SV, Pechonkina EA. Prevalence of the metabolic syndrome in Siberia: populationbased study in Novosibirsk. The Bulletin of the SB RAMS 2011; 31 (5): 100-6. (in Russian)

11. Kayumova M.M., Gakova E.I., Gorbunova T.Y., Akimov M.Y. The prevalence of abdominal obesity in men of an open urban population. Siberian Scientific Medical Journal. 2018; 38(6): 118-123. (In Russian) https://doi.org/10.15372/SSMJ20180617

12. Research organizing committee of the ESSE-RF project. Epidemiology of cardiovascular diseases in different regions of Russia (ESSE-RF). The rationale for and design of the study J. Profilakticheskaya meditsina. 2013; 6: 25-34. (In Russian)

13. Evdokimova A.A., Mamedov M.N., Shalnova S.A., Deev A.D., Tokareva Z.N., Eganian R.A., Oganov R.G.Assessment of the prevalence of risk factors in a random urban sample of men and women. Profilakticheskaya meditsina. 2010; (2): 3-8. (In Russian)

14. Rotar O.P., Libis R.A., Isaeva E.N., Erina A.M., Shavshin D.A., Moguchaya E.V., Kolesova E.P., Boyarinova M.A., Moroshkina N.V., Yakovleva O.I., Solntsev V.N., Konradi A.O., Shlyakhto E.V.. Metabolic syndrome prevalence in Russian cities. Russian Journal of Cardiology. 2012; (2): 5562. (In Russian)

15. Joulaei H., Maharlouei N., Lankarani K., Razzaghi A., Akbari M. Narrative review of women's health in Iran: challenges and successes. Int J Equity Health. 2016; 15: 25. doi: 10.1186/s12939-016-0316-x.

16. Garvey W.T., Garber A.J., Mechanick J.I., Bray G.A., Dagogo-Jack S., Einhorn D., Grunberger G., Handelsman Y., Hennekens C.H., Hurley D.L., McGill J., Palumbo P., Umpierrez G.; The Aace Obesity Scientific Committee. American association of clinical endocrinologists and american college of endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract. 2014 Sep;20(9):977-89. doi: 10.4158/EP14280.PS.

17. Kim S.K., Kim H.J., Hur K.Y., Choi S.H., Ahn C.W., Lim S.K., Kim K.R., Lee H.C., Huh K.B., Cha B.S. Visceral fat thickness measured by ultrasonography can estimate not only visceral obesity but also risks of cardiovascular and metabolic diseases. Am J Clin Nutr. 2004; 79: 593-599. doi: 10.1093/ajcn/79.4.593.

18. Empana J.P., Duciemetiere P., Balkau B., Jouven X. Contribution of the metabolic syndrome to sudden death risk in asymptomatic men: the Paris Prospective Study I. Eur. Heart J. 2007; 28: 1149- 1154. doi: 10.1093/eurheartj/ehm063.

19. Erlikh A.D. Twelve months outcomes in patients with acute coronary syndrome, by the national registry RECORD-3. Russian Journal of Cardiology. 2018; (3): 23-30. (In Russian.) https://doi.org/10.15829/1560-4071-2018-3-23-30.

20. German A.I., Fedorova N.V., Pecherina T.B., Chernobaj A.G., Gruzdeva O.V., Karetnikova V.N., Kashtalap V.V.Obesity impact on the clinical course of myocardial infarction. RMJ. Medical Review. 2019;1(II):70-75. (in Russian)

21. Chung S.C., Gedeborg R., Nicholas O. James S., Jeppsson A., Wolfe C., Heuschmann P., Wallentin L., Deanfield J., Timmis A., Jernberg T., Hemingway H. Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and in the UK. Lancet. 2014; 383: 1305-1312. doi: 10.1016/S0140-6736(13)62070-X..

22. Coutinho T., Goel K., Correa de Sa D., Carter R.E., Hodge D.O., Kragelund C., Kanaya A.M., Zeller M., Park J.S., Kober L., Torp-Pedersen C., Cottin Y., Lorgis L., Lee S.H., Kim Y.J., Thomas R., Roger V.L., Somers V.K., Lopez-Jimenez F. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: role of "normal weight central obesity". J Am Coll Cardiol. 2013; 61(5): 553-560. doi: 10.1016/j.jacc.2012.10.035.

23. Kim H.K., Jeong M.H., Ahn Y., Kim J.H., Chae S.C., Kim Y.J., Hur S.H., Seong I.W., Hong T.J., Choi D.H., Cho M.C., Kim C.J., Seung K.B., Chung W.S., Jang Y.S., Rha S.W., Bae J.H., Cho J.G., Park S.J; Other Korea Acute Myocardial Infarction Registry Investigators. Hospital discharge risk score system for the assessment of clinical outcomes in patients with acute myocardial infarction (Korea Acute Myocardial Infarction Registry [KAMIR] score). Am J Cardiol. 2011; 107(7): 965-71. doi: 10.1016/j.amjcard.2010.11.018.

24. Gupta P.P., Fonarow G.C., Horwich T.B. Obesity and the obesity paradox in heart failure. Can J Cardiol. 2015; 31: 195-202. doi: 10.1016/j.cjca.2014.08.004.

25. Gruberg L., Weissman N.J., Waksman R. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol. 2002; 39(4): 578-584. doi: 10.1016/s0735-1097(01)01802-2.

26. Sharma A., Vallakati A., Einstein A.J., Lavie C.J., Arbab-Zadeh A., Lopez-Jimenez F., Mukherjee D., Lichstein E. Relationship of Body Mass Index with Total Mortality, Cardiovascular Mortality, and Myocardial Infarction After Coronary Revascularization: Evidence from a Meta-analysis. Mayo Clin Proc. 2014; 89(8): 1080-1100. doi: 10.1016/j.mayocp.2014.04.020.

27. Kang W.Y., Jeong M.H., Ahn Y.K., Kim J.H., Chae S.C., Kim Y.J., Hur S.H., Seong I.W., Hong T.J., Choi D.H., Cho M.C., Kim C.J., Seung K.B., Chung W.S., Jang Y.S., Rha S.W., Bae J.H., Cho J.G., Park S.J.; Korea Acute Myocardial Infarction Registry Investigators. Obesity paradox in Korean patients undergoing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. J Cardiol. 2010; 55(1): 84-91. doi: 10.1016/j.jjcc.2009.10.004.

28. Drapkina O.M., Shepel R.N. Chronic heart failure and the “obesity paradox”. Russian Heart Failure Journal. 2016; 17(6): 398-404 (in Rusian)

29. Mehta L., Delvlin W., McCullough P.A., O'Neill W.W., Skelding K.A., Stone G.W., Boura J.A., Grines C.L. Impact of body mass index on outcomes after percutaneous coronary intervention in patients with acute myocardial infarction. Am. J. Cardiol. 2007; 99: 906-910. doi: 10.1016/j.amjcard.2006.11.038.

30. Diercks D.B., Roe M.T., Mulgund J., Pollack C.V. Jr., Kirk J.D., Gibler W.B., Ohman E.M., Smith S.C.Jr., Boden W.E., Peterson E.D. The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative. AmHeartJ. 2006; 152: 140-8. doi: 10.1016/j.ahj.2005.09.024.

31. Niedziela J., Hudzik B., Niedziela N., Gqsior M., Gierlotka M., Wasilewski J., Myrda K., Lekston A., Polonski L., Rozentryt P. The obesity paradox in acute coronary syndrome: a meta-analysis. Eur J Epidemiol. 2014; 29: 801-812. doi 10.1007/s10654-014-9961-9.

32. Mosterd A., Cost B., Hoes A.W., de Bruijne M.C., Deckers J.W., Hofman A., Grobbee D.E. The prognosis of heart failure in the general population: The Rotterdam Study. Eur Heart J. 2001; 22(15): 1318-1327. doi: 10.1053/euhj.2000.2533.

33. Morrow D.A., Scirica B.M., Karwatowska-Prokopczuk E., Murphy S.A., Budaj A., Varshavsky S., Wolff A.A., Skene A., McCabe C.H., Braunwald E.; MERLIN-TIMI 36 Trial Investigators.. Effects of ranolazine on recurrent cardiovascular events in patients with non-ST-elevation acute coronary syndromes: the MERLIN-TIMI 36 randomized trial. JAMA. 2007; 297(16): 1775-83. doi: 10.1001/jama.297.16.1775.

34. Romero-Corral A., Montori V.M., Somers V.K., Korinek J., Thomas R.J., Allison T.G., Mookadam F., Lopez-Jimenez F. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006; 368(9536): 666-78. doi: 10.1016/S0140-6736(06)69251-9.

35. Ott A.V., Chumakova G.A. Epicardial obesity as one of the basic criteria for metabolically unhealthy obesity phenotype and the predictor of subclinical atherosclerosis. Complex Issues of Cardiovascular Diseases. 2018; 7(1): 21-28. (In Russian) https://doi.org/10.17802/2306-1278-2018-7-1-21-28.

36. Kvitkova L.V., Borodkina D.A., Gruzdeva O.V. Metabolic signs of abdominal burn in patients with acute myocardial infarction with normal and increased body weight. Problems of endocrinology. 2012; 4: 27-31. (In Russian)

37. Morris R.M., Caughey D.E., Mercer C.J., Scott P.J. Prognosis after myocardial infarction. Six-year follow-up. Br Heart J. 1974; 36: 786-790. doi: 10.1136/hrt.36.8.786

38. Menascha P., Alfieri O., Janssens S., McKenna W., Reichenspurner H., Trinquart L., Vilquin J.T., Marolleau J.P., Seymour B., Larghero J., Lake S., Chatellier G., Solomon S., Desnos M., Hagege A.A. The myoblast autologous grafting in ischemic cardiomyopathy (MAGIC) trial. First randomized placebo-controlled study of myoblast transplantation. Circulation. 2008; 117: 1189-200. doi: 10.1161/CIRCULATIONAHA.107.734103.

39. Lavie C.J., De Schutter A., Patel D.A., Romero-Corral A., Artham S.M., Milani R.V. Body composition and survival in stable coronary heart disease: impact of lean mass index and body fat in the "obesity paradox". J Am Coll Cardiol. 2012; 60(15): 1374-80. doi: 10.1016/j.jacc.2012.05.037.

40. Padwal R., McAlister F.A., McMurray J.J., Cowie M.R., Rich M., Pocock S., Swedberg K., Maggioni A., Gamble G., Ariti C., Earle N., Whalley G., Poppe K.K., Doughty R.N., Bayes-Genis A.; Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data. Int J Obes (Lond). 2014; 38(8): 110-4. doi: 10.1038/ijo.2013.203.