Abstract 18271: The Association Between Obesity and Coronary Artery Disease Detected During Non-Emergent Angiography: a Comparison Between Black and White Patients

Abstract

Introduction: Despite known associations between obesity and the development of cardiovascular disease, the relationship between obesity as reflected by BMI and angiographically demonstrated CAD is not fully understood. Moreover, this relationship has not been adequately defined in black patients, a group demonstrated to have lower rates of angiographic CAD despite higher rates of traditional CAD risk factors, cardiovascular events, and CAD-related mortality. Methods: Using an angiography database from a single academic hospital, we studied patients undergoing first-time, non-emergent angiography from 2001 to 2010. From this cohort, we selected those lacking a previous CAD diagnosis, without previous cardiac intervention, and with complete anthropomorphic measures and outcome data. Using models that controlled for patient demographics and CAD risk factors, we compared rates of angiographic disease for blacks and whites by obesity status (BMI ≥ 30 kg/m2). Significant CAD was defined by the presence of a significant lesion (≥50% stenosis in the left main artery or ≥70% stenosis elsewhere), and also quantified by a modified Gensini score of global disease. Results: We identified 4,022 white and 1,963 black eligible patients. Black patients had higher rates of diabetes and hypertension, and were more likely to be obese than whites (OR 1.85; 95% CI 1.65-2.06). Nevertheless, black patients were less likely to have a significant stenosis (adjusted OR 0.57; 95% CI 0.48-0.66), and were found to have a lower mean Gensini score (7.33 vs. 8.83, P=0.001). Obesity was not associated with the presence of CAD. In fact, black obese patients were significantly less likely to have a severe stenosis than their non-obese counterparts, and there was a non-significant trend for obese patients of both races to have less disease than non-obese patients using the Gensini score. Conclusions: Black patients in this cohort were more likely to be obese than white patients yet were far less likely to have significant CAD. Moreover, obesity itself was not positively associated with the presence or severity of CAD, suggesting that obesity may lead to cardiovascular morbidity and mortality by mechanisms other than the development of atherosclerosis, particularly in black patients.