Morbid Obesity is Not a Risk Factor for the Development of Clinically Significant Coronary Artery Atherosclerosis

Abstract

Morbid obesity represents a significant health problem to a large and growing segment of the industrialized world. The cardiovascular complications are numerous and include systemic and pulmonary hypertension, obesity cardiomyopathy, heart failure, left ventricular dilatation and hypertrophy, arrhythmias, and sudden cardiac death. Morbidly obese (MO) individuals who die suddenly and unexpectedly may not have significant coronary artery atherosclerosis or acutely lethal natural diseases at autopsy. In this way, forensic pathologists may be challenged to understand the mechanism of sudden death when the major anatomic finding is often limited to cardiomegaly with or without chamber dilatation and wall thickening. The death investigation files for a large metropolitan medical examiner department were the source of data in this case-control retrospective study. A total of 3863 cases met inclusion criteria. The following data were obtained: sex, age, cause of death, manner of death, weight in pounds, height in inches, body mass index, heart weight in grams, and coronary artery atherosclerosis (CAA) severity. A population of MO decedents (N = 1290) was identified, and sex- and age-matched case controls of non-obese decedents (N = 2573) were selected. The degree of CAA was recorded for all major vascular territories in both MO decedents and control cases, and there was no statistically significant difference in CAA between decedents in the MO group and the control group. These data illustrate that obesity is not a significant independent risk factor for CAA.