Obesity paradox in acute myocardial infarction: Is plasminogen activator inhibitor 1 the culprit?

Abstract

The obesity paradox continues to puzzle scientists. The unexpected observation of a higher incidence but more favorable outcomes in obese patients has been described in several cardiovascular and non-cardiovascular conditions. A number of possible causes of the paradox have been proposed. Plasminogen activator inhibitor 1 (PAI-1) has not yet been evaluated in this context. Our study group investigated the prognostic value of PAI-1 dynamics in the early stages of acute ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention. A higher rise in PAI-1 activity within 24 h of STEMI was associated with worse long-term outcomes. Within the study population, which involved 87 consecutive patients, we observed a certain pattern of PAI-1 dynamics that may be protective in obese patients. In these patients, initial PAI-1 activity levels were elevated, a fact in line with the higher incidence of acute coronary syndromes in the obese population. However, the increase in PAI-1 activity during first 24 h of STEMI was not as pronounced in obese patients. It is our hypothesis that this correlation may prove protective in this population. If confirmed in larger studies, this observation may provide a piece of the puzzle towards elucidating the origins of the obesity paradox, as well as further promote the development of PAI-1 inhibitors as a viable therapeutic option for STEMI patients.